The Implementation of a Tobacco Use Registry in an Academic Family Practice

Abstract

Purpose: Patients who use tobacco often are not provided evidence-based interventions because of barriers such as lack of time or expertise. Using a chronic disease model, we sought to improve delivery of care with an innovative decision support tool and a tobacco use registry.Methods: We designed and implemented a decision support tool in an academic family medicine clinic. To assess barriers, we measured duration of visit and provider confidence (scale of 0 -10) in prescribing cessation medications before and after the introduction of the tool. We examined fidelity through daily counts of returned forms.Results: No significant differences in mean office visit cycle times occurred for tobacco users (64.7 vs 63.1 minutes; P ‫؍‬ .90) or between tobacco users and nontobacco users (63.1 vs 62.5 minutes; P ‫؍‬ 1.00) before or after implementation of the decision support tool. Mean provider confidence in prescribing cessation medications increased significantly for nicotine inhalers (4.8 vs 6.4; P ‫؍‬ .01), nicotine nasal spray (3.9 vs 5.5; P ‫؍‬ .03) and combination nicotine replacement therapy (5.5 vs 6.2; P ‫؍‬ .05). Two years after implementation, 88% of forms were filled out and returned daily, and >2200 tobacco users have been entered into the registry.

Patient Care Outcomes of a Tobacco Use Registry in an Academic Family Practice

“…3 We believe that the information in the tobacco use registry decision support tool on appropriate dosing and medication guidelines may have contributed to providers having easier access to and reminders about the 7 US Food and Drug Administration-approved cessation medications. 17 The FMC tobacco use disease registry incorporated a team approach (eg, including medical assistants in the decision support tool process). Studies show that advice from multiple providers increases quit attempts.…”

Bringing Patients Into the Patient-Centered Medical Home: Lessons Learned in a Large Primary Care Practice

“…There have been persistent calls for dramatic changes in the model of primary care-from reports by the National Academy of Medicine [3,4], from the Future of Family Medicine report [1], and from the Joint Statement on the Patient Centered Medical Home [5]. Following these leads, the UNC Family Medicine Center implemented advanced access [6,7], designed new coordinated systems of care for chronic disease (including diabetes and congestive heart failure) [8,9], and began to systematically address tobacco use in our practice [10,11]. We obtained and renewed PCMH recognition [12], embedded social work care management [13], launched a new home-based care service, implemented interventions to reduce hospital readmissions, and built a regional system of care for uninsured patients in collaboration with partners in the UNC Health Care System [14], Piedmont Health Services, and Community Care of Central Carolina.…”

Data Supporting Key Components of Family Medicine--Scope, Continuity, Interprofessional Care, and More

“…Two companion articles are included in this issue, one on implementing a tobacco use registry 4 and the other on an accompanying decision support tool. 5 The registry went beyond merely noting whether patients smoked or not, and included various actions and status related to tobacco use. The registry showed some positive influences that can lead to decreased tobacco use in the long term; as we know, smoking cessation often requires multiple attempts over years before success becomes permanent.…”