The ONE Step Initiative: Quality Improvement in a Pediatric Clinic for Secondhand Smoke Reduction

Abstract

BACKGROUND AND OBJECTIVE: Although comprehensive smoking counseling to limit secondhand smoke (SHS) is widely endorsed, it is often not done. Published evaluations of brief and practical systems that improve screening and counseling to reduce SHS are limited. Our objective was to determine if a quality improvement activity around smoking counseling leads to changes in (1) medical assistant and pediatric provider assessment of smoking history and (2) smoking or other behaviors affecting children' s SHS exposure. METHODS:In a large urban teaching clinic we assessed the ONE Step intervention, which included the following: (1) "Ask" (medical assistant asking whether caregivers smoke); (2) "Advise" (providers advising smoking outside and quitting if ready); (3) "Refer" (providers referring to the Colorado telephone QuitLine); and (4) electronic medical record prompts and required documentation regarding smoking. Medical assistant and provider assessments of smoking were evaluated with a chart review by using a pre-/posttest design. Caregiver behavior change was evaluated with a time-series survey that included assessment at baseline and follow-up via telephone at 6 and 12 months from study entry. RESULTS: ONEStep was associated with a statistically significant increase in Ask, Advise, and Refer documentation. Caregiver surveys showed that 97% found discussions of SHS with providers acceptable. Six-and 12-month follow-ups, respectively, showed that 14% and 13% of smokers reported quitting and that 63% and 70% of current smokers reported reduced SHS exposure. CONCLUSIONS: ONEStep was feasible to deliver in a busy outpatient setting, acceptable to families, and appears to have resulted in decreased exposure to SHS in our pediatric population. Pediatrics 2013;132:e502-e511 AUTHORS:

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

“…A final variable was caregivers' and pediatricians' acceptance of smoking cessation discussions being conducted during pediatric office visits (Beaty et al, 2013;Bunik et al, 2013; J. D. Klein et al, 1995;Sharifi et al, 2014). …”

“…Some studies did not test for possible confounders such as age, gender, physician training, residency tract, number of patient visits per year, past use of tobacco products, living with a smoker, previous tobacco education, self-education in tobacco cessation and knowledge of SHS risks was not tested in some studies (Beaty et al, 2013;Bunik et al, 2013;Garg et al, 2007;Sharifi et al, 2014). These factors may influence self-reports and should be measured when considering the validity of an intervention.…”

“…A pre-post study design was used in the majority of studies (Beaty et al, 2013;Bunik et al, 2013;Garg et al, 2007;Hymowitz et al, 2008;Hymowitz et al, 2001; J. D. Klein et al, 1995;Scal et al, 2004;Sharifi et al, 2014). In a pre-post study design, a control group is absent.…”

“…As a result, the American Academy of Pediatrics (AAP) has advocated the importance of promoting smoking cessation at every visit (Bunik et al, 2013;Fiore et al, 2008;A.A.o Pediatrics, 1997). Despite this, discrepancies between recommendations and clinical practice exist.…”

“…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.…”