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

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. (J Am Board Fam Med 2009; 22: 625-632.)