Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care

Abstract

We created a clinical decision support (CDS) tool and evaluated its feasibility, acceptability, usability, and clinical impact within the electronic health record to help primary care pediatricians provide smoking cessation treatment to parents/caregivers who smoke. METHODS:This prospective study of pediatric clinicians and parents was conducted at 1 urban primary care site. Clinicians received training in smoking cessation counseling, nicotine replacement therapy (NRT) prescribing, referral to an adult treatment program, and use of the CDS tool. The tool prompted clinicians to ask about secondhand smoke exposure, provide an electronic NRT prescription, and refer. Feasibility was measured by using electronic health record utilization data, and acceptability and usability were assessed with the use of clinician surveys. Parents reported clinical impact, including NRT accepted and used.RESULTS: From June to August 2015, clinicians used the tool to screen for secondhand smoke exposure at 2286 (76%) of 3023 visits. Parent smokers were identified at 308 visits, and 165 parents (55% of smokers) were interested in and offered treatment. Twenty-four (80%) of 30 eligible pediatric clinicians used the tool. Ninety-four percent of clinicians surveyed (n = 17) were satisfied with the tool, and the average system usability scale score was 83 of 100 (good to excellent range). We reached 69 of 100 parents sampled who received treatment; 44 (64%) received NRT, and 17 (25%) were currently using NRT. CONCLUSIONS:A CDS tool to help urban primary care pediatric clinicians provide smoking cessation treatment was feasible, acceptable, usable, and influenced clinical care. A larger scale investigation in varied practice settings is warranted.

Addressing critical gaps in the treatment of eating disorders

“…Checklists can help the clinician ensure that important topics and points are covered when caring for patients and can also aid in decision‐making. For instance, a clinical decision support tool to help clinicians deliver smoking cessation treatment, which prompts clinicians to ask patients specific questions, has preliminary support for its feasibility and acceptability in clinical care (Jenssen, Bryant‐Stephens, Leone, Grundmeier, & Fiks, ). Furthermore, Recovery Record, a direct‐to‐consumer mobile app that has been downloaded >100,000 times over two years, can be used by individuals with eating disorders to self‐monitor meals, emotions, behaviors, and thoughts and share this information with their therapist (Tregarthen, Lock, & Darcy, ).…”

Tobacco Use Assessment and Treatment in Cancer Patients: A Scoping Review of Oncology Care Clinician Adherence to Clinical Practice Guidelines in the U.S.

“…Clinical reminders and decision support systems within the EHR can also reduce clinician burden in providing TUT. These systems have been implemented in a variety of settings to improve adherence to TUT guidelines and are cost‐effective, sustainable, feasible, and acceptable . Computerized clinical reminders increase the likelihood of documentation, engagement in counseling, and medication prescriptions, and they require minimal training to implement .…”

“…Clinical reminders and decision support systems within the EHR can also reduce clinician burden in providing TUT. These systems have been implemented in a variety of settings to improve adherence to TUT guidelines and are cost-effective, sustainable, feasible, and acceptable [42][43][44][45][46]. .…”

Smoking cessation promotion in the pediatric clinic: Increasing pediatricians’ rate of screening for second hand smoke exposure, counseling caregivers to stop smoking and referring caregivers to smoking cessation programs

“…This study revealed that pediatricians found this intervention feasible, acceptable, and usable in promoting smoking cessation (Jenssen BP, 2016). However, this study differed from ours in primary purpose (which was to assess the acceptability, feasibility and usability of the intervention), study design (a prospective study in which all participants received the same treatment) and data collection (assessed via self-reports).…”

“…Studies have demonstrated that including relevant prompts in electronic health records (EHRs) can increase smoking cessation promotion in the pediatric clinic (Bunik et al, 2013;Jenssen BP, 2016;Sharifi et al, 2014). To the best of our knowledge, no study has directly compared the effects of a lecture plus EHR prompts, EHR prompts alone, and a lecture alone, on various parameters of smoking cessation promotion.…”