, Volume 3, Issue 3, pp 253-263

Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record

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ABSTRACT

Almost 35 million U.S. smokers visit primary care clinics annually, creating a need and opportunity to identify such smokers and engage them in evidence-based smoking treatment. The purpose of this study is to examine the feasibility and effectiveness of a chronic care model of treating tobacco dependence when it is integrated into primary care systems using electronic health records (EHRs). The EHR prompted primary care clinic staff to invite patients who smoked to participate in a tobacco treatment program. Patients who accepted and were eligible were offered smoking reduction or cessation treatment. More than 65 % of smokers were invited to participate, and 12.4 % of all smokers enrolled in treatment—30 % in smoking reduction and 70 % in cessation treatment. The chronic care model developed for treating tobacco dependence, integrated into the primary care system through the EHR, has the potential to engage up to 4.3 million smokers in treatment a year.

Implications

Practice: Electronic health records (EHRs) should be used to prompt primary care clinic staff to offer all smokers evidence-based smoking interventions, with treatment provided by non-physician clinical staff.
Policy: Healthcare systems should implement a chronic care approach to treating smokers that uses the EHR to identify and offer treatment to all tobacco users at every visit and then provide care via trained chronic care case managers.
Research: Research needs to determine optimal ways of using the EHR to organize tobacco interventions and the effectiveness of incorporating chronic care approaches (including smoking reduction interventions) into healthcare delivery.