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Smoking As a Vital Sign: Prompts to Ask and Assess Increase Cessation Counseling

From the Nicotine Dependence Program, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill

Correspondence: Corresponding author: Anna McCullough, Department of Family Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599-7595 (E-mail: annamc{at}unc.edu)

Background: Strategies to improve smoking cessation counseling in clinical settings are critical to supporting smokers’ attempts to quit. This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification, assessment, and counseling for patients who smoke: "Current smoker?" and "Plan to quit?"

Methods: Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics.

Results: From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P < .001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P < .005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P = .41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P < .001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095–0.456).

Conclusions: Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling.

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