Translational Behavioral Medicine

, Volume 3, Issue 3, pp 253–263 | Cite as

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

  • Megan E Piper
  • Timothy B Baker
  • Robin Mermelstein
  • Linda M Collins
  • David L Fraser
  • Douglas E Jorenby
  • Stevens S Smith
  • Bruce A Christiansen
  • Tanya R Schlam
  • Jessica W Cook
  • Madeline Oguss
  • Michael C Fiore
Original Research

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.

KEYWORDS

Chronic care smoking treatment Translational research Smoking cessation Primary care Recruitment Electronic health record 

References

  1. 1.
    Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz N, Curry SJ, et al. Treating tobacco use and dependence: 2008 update. Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service; 2008.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1995–1999. MMWR. 2002;51:300-303.Google Scholar
  3. 3.
    Ong MK, Zhou Q, Sung HY. Primary care providers advising smokers to quit: comparing effectiveness between those with and without alcohol, drug, or mental disorders. Nicotine Tob Res. 2011;13:1193-1201.PubMedCrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. Quitting smoking among adults - United States 2001–2010. MMWR. 2011;60:1513-1519.Google Scholar
  5. 5.
    Wittchen HU, Hoch E, Klotsche J, Muehlig S. Smoking cessation in primary care—a randomized controlled trial of bupropione, nicotine replacements, CBT and a minimal intervention. Int J Methods Psychiatr Res. 2011;20:28-39.PubMedCrossRefGoogle Scholar
  6. 6.
    Fiore MC, McCarthy DE, Jackson TC, et al. Integrating smoking cessation treatment into primary care: an effectiveness study. Prev Med. 2004;38:412-420.PubMedCrossRefGoogle Scholar
  7. 7.
    Stapleton JA, Sutherland G. Treating heavy smokers in primary care with the nicotine nasal spray: randomized placebo-controlled trial. Addiction. 2011;106:824-832.PubMedCrossRefGoogle Scholar
  8. 8.
    Rigotti NA, Bitton A, Kelley JK, Hoeppner BB, Levy DE, Mort E. Offering population-based tobacco treatment in a healthcare setting: a randomized controlled trial. Am J Prev Med. 2011;41:498-503.PubMedCrossRefGoogle Scholar
  9. 9.
    Smit ES, Hoving C, Cox VC, de Vries H. Influence of recruitment strategy on the reach and effect of a web-based multiple tailored smoking cessation intervention among Dutch adult smokers. Health Educ Res. 2012;27:191-199.PubMedCrossRefGoogle Scholar
  10. 10.
    Wagner EH. The role of patient care teams in chronic disease management. BMJ. 2000;320(7234):569-572.PubMedCrossRefGoogle Scholar
  11. 11.
    Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20:64-78.PubMedCrossRefGoogle Scholar
  12. 12.
    Fiore MC, Bailey WC, Cohen SJ. Treating tobacco use and dependence: clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service; 2000.Google Scholar
  13. 13.
    Carpenter MJ, Hughes JR, Gray KM, Wahlquist AE, Saladin ME, Alberg AJ. Nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit: a randomized clinical trial. Arch Intern Med. 2011;171:1901-1907.PubMedCrossRefGoogle Scholar
  14. 14.
    Carpenter MJ, Hughes JR, Solomon LJ, Callas PW. Both smoking reduction with nicotine replacement therapy and motivational advice increase future cessation among smokers unmotivated to quit. J Consult Clin Psychol. 2004;72:371-381.PubMedCrossRefGoogle Scholar
  15. 15.
    Etter JF, Laszlo E, Perneger TV. Postintervention effect of nicotine replacement therapy on smoking reduction in smokers who are unwilling to quit: randomized trial. J Clin Psychopharmacol. 2004;24:174-179.PubMedCrossRefGoogle Scholar
  16. 16.
    Bentz CJ, Bayley KB, Bonin KE, Fleming L, Hollis JF, McAfee T. The feasibility of connecting physician offices to a state-level tobacco quit line. Am J Prev Med. 2006;30:31-37.PubMedCrossRefGoogle Scholar
  17. 17.
    Frank O, Litt J, Beilby J. Opportunistic electronic reminders. Improving performance of preventive care in general practice. Aust Fam Physician. 2004;33:87-90.PubMedGoogle Scholar
  18. 18.
    Linder JA, Rigotti NA, Schneider LI, Kelley JH, Brawarsky P, Haas JS. An electronic health record-based intervention to improve tobacco treatment in primary care: a cluster-randomized controlled trial. Arch Intern Med. 2009;169:781-787.PubMedCrossRefGoogle Scholar
  19. 19.
    Lindholm C, Adsit R, Bain P, et al. A demonstration project for using the electronic health record to identify and treat tobacco users. WMJ. 2010;109:335-340.PubMedGoogle Scholar
  20. 20.
    Baker TB, Mermelstein R, Collins LM, et al. New methods for tobacco dependence treatment research. Ann Behav Med. 2011;41:192-207.PubMedCrossRefGoogle Scholar
  21. 21.
    Joseph AM, Fu SS, Lindgren B, et al. Chronic disease management for tobacco dependence: a randomized, controlled trial. Arch Intern Med. 2011;171:1894-1900.PubMedCrossRefGoogle Scholar
  22. 22.
    Benowitz NL. Chronic disease management approach to treating tobacco addiction: comment on “nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit”. Arch Intern Med. 2011;171:1907-1909.PubMedCrossRefGoogle Scholar
  23. 23.
    Hung DY, Rundall TG, Tallia AF, Cohen DJ, Halpin HA, Crabtree BF. Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors. Milbank Q. 2007;85:69-91.PubMedCrossRefGoogle Scholar
  24. 24.
    Hung DY, Shelley DR. Multilevel analysis of the chronic care model and 5A services for treating tobacco use in urban primary care clinics. Health Serv Res. 2009;44:103-127.PubMedCrossRefGoogle Scholar
  25. 25.
    Moore D, Aveyard P, Connock M, Wang D, Fry-Smith A, Barton P. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ. 2009;338:b1024.PubMedCrossRefGoogle Scholar
  26. 26.
    Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev. 2010; (1):CD006936.Google Scholar
  27. 27.
    Aubert RE, Herman WH, Waters J, et al. Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized, controlled trial. Ann Intern Med. 1998;129:605-612.PubMedCrossRefGoogle Scholar
  28. 28.
    Wagner EH. More than a case manager. Ann Intern Med. 1998;129:654-656.PubMedCrossRefGoogle Scholar
  29. 29.
    Coleman K, Mattke S, Perrault PJ, Wagner EH. Untangling practice redesign from disease management: how do we best care for the chronically ill? Annu Rev Public Health. 2009;30:385-408.PubMedCrossRefGoogle Scholar
  30. 30.
    Smith SA, Shah ND, Bryant SC, et al. Chronic care model and shared care in diabetes: randomized trial of an electronic decision support system. Mayo Clin Proc. 2008;83:747-757.PubMedCrossRefGoogle Scholar
  31. 31.
    Lichtenstein E, Hollis JF, Severson HH, et al. Tobacco cessation interventions in health care settings: rationale, model, outcomes. Addict Behav. 1996;21:709-720.PubMedCrossRefGoogle Scholar
  32. 32.
    DesRoches CM, Campbell EG, Rao SR, et al. Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med. 2008;359:50-60.PubMedCrossRefGoogle Scholar
  33. 33.
    Hsiao C-J, Hing E, Socey TC, Cai B. Electronic medical record. Electronic health record systems of office-based physicians: United States, 2009 and preliminary 2010 estimates2010: Available from: http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.htm.
  34. 34.
    Pear R. U.S. issues rules on electronic health records. New York Times. 2010 July 13.Google Scholar
  35. 35.
    Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database Syst Rev. 2011; (Issue 12. Art. No.: CD008743).Google Scholar
  36. 36.
    Boyle RG, Solberg LI, Fiore MC. Electronic medical records to increase the clinical treatment of tobacco dependence: a systematic review. Am J Prev Med. 2010;39(6 Suppl 1):S77-S82.PubMedCrossRefGoogle Scholar
  37. 37.
    Bentz CJ, Davis N, Bayley B. The feasibility of paper-based tracking codes and electronic medical record systems to monitor tobacco-use assessment and intervention in an Individual Practice Association (IPA) model health maintenance organization (HMO). Nicotine Tob Res. 2002;4(Suppl 1):S9-S17.PubMedCrossRefGoogle Scholar
  38. 38.
    Spencer E, Swanson T, Hueston WJ, Edberg DL. Tools to improve documentation of smoking status. Continuous quality improvement and electronic medical records. Arch Fam Med. 1999;8:18-22.PubMedCrossRefGoogle Scholar
  39. 39.
    Bentz CJ, Bayley BK, Bonin KE, et al. Provider feedback to improve 5A’s tobacco cessation in primary care: a cluster randomized clinical trial. Nicotine Tob Res. 2007;9:341-349.PubMedCrossRefGoogle Scholar
  40. 40.
    Sherman SE, Takahashi N, Kalra P, et al. Care coordination to increase referrals to smoking cessation telephone counseling: a demonstration project. Am J Manag Care. 2008;14:141-148.PubMedGoogle Scholar
  41. 41.
    Szpunar SM, Williams PD, Dagroso D, Enberg RN, Chesney JD. Effects of the tobacco use cessation automated clinical practice guideline. Am J Manag Care. 2006;12:665-673.PubMedGoogle Scholar
  42. 42.
    Fraser D, Baker TB, Fiore MC, Adsit RA, Christiansen BA. Electronic health records (EHR) as a tool for recruitment of participants in clinical effectiveness research: lesson learned from tobacco cessation. Transl Behav Med. in press.Google Scholar
  43. 43.
    Collins LM, Baker TB, Mermelstein RJ, et al. The multiphase optimization strategy for engineering effective tobacco use interventions. Ann Behav Med. 2011;41:208-226.PubMedCrossRefGoogle Scholar
  44. 44.
    Raue PJ, Schulberg HC, Heo M, Klimstra S, Bruce ML. Patients’ depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study. Psychiatr Serv. 2009;60:337-343.PubMedCrossRefGoogle Scholar
  45. 45.
    Hunot VM, Horne R, Leese MN, Churchill RC. A cohort study of adherence to antidepressants in primary care: the influence of antidepressant concerns and treatment preferences. Prim Care Companion J Clin Psychiatry. 2007;9:91-99.PubMedCrossRefGoogle Scholar
  46. 46.
    Aveyard P, Begh R, Parsons A, West R. Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. 2012;107:1066-1073.PubMedCrossRefGoogle Scholar
  47. 47.
    Hughes JR. Reduced smoking: an introduction and review of the evidence. Addiction. 2000;95(Suppl 1):S3-S7.PubMedGoogle Scholar
  48. 48.
    Hughes JR, Carpenter MJ. The feasibility of smoking reduction: an update. Addiction. 2005;100:1074-1089.PubMedCrossRefGoogle Scholar
  49. 49.
    Katz DA, Muehlenbruch DR, Brown RL, Fiore MC, Baker TB. Effectiveness of implementing the agency for healthcare research and quality smoking cessation clinical practice guideline: a randomized, controlled trial. J Natl Cancer Inst. 2004;96:594-603.PubMedCrossRefGoogle Scholar
  50. 50.
    Joseph AM, Arikian NJ, An LC, Nugent SM, Sloan RJ, Pieper CF. Results of a randomized controlled trial of intervention to implement smoking guidelines in Veterans Affairs medical centers: increased use of medications without cessation benefit. Med Care. 2004;42:1100-1110.PubMedCrossRefGoogle Scholar
  51. 51.
    Sherman SE, Estrada M, Lanto AB, Farmer MM, Aldana I. Effectiveness of an on-call counselor at increasing smoking treatment. J Gen Intern Med. 2007;22:1125-1131.PubMedCrossRefGoogle Scholar
  52. 52.
    Piper ME, Fiore MC, Smith SS, et al. Use of the vital sign stamp as a systematic screening tool to promote smoking cessation. Mayo Clin Proc. 2003;78:716-722.PubMedCrossRefGoogle Scholar
  53. 53.
    Papadakis S, McDonald P, Mullen KA, Reid R, Skulsky K, Pipe A. Strategies to increase the delivery of smoking cessation treatments in primary care settings: a systematic review and meta-analysis. Prev Med. 2010;51:199-213.PubMedCrossRefGoogle Scholar
  54. 54.
    McIntosh S, Ossip-Klein DJ, Spada J, Burton K. Recruitment strategies and success in a multi-county smoking cessation study. Nicotine Tob Res. 2000;2:281-284.PubMedCrossRefGoogle Scholar
  55. 55.
    Thompson RS, Michnich ME, Friedlander L, Gilson B, Grothaus LC, Storer B. Effectiveness of smoking cessation interventions integrated into primary care practice. Med Care. 1988;26:62-76.PubMedCrossRefGoogle Scholar
  56. 56.
    McPhee SJ, Bird JA, Fordham D, Rodnick JE, Osborn EH. Promoting cancer prevention activities by primary care physicians. Results of a randomized, controlled trial. JAMA. 1991;266:538-544.PubMedCrossRefGoogle Scholar
  57. 57.
    Ockene JK. Primary care-based smoking interventions. Nicotine Tob Res. 1999;1(Suppl 2):S189-S193.PubMedCrossRefGoogle Scholar
  58. 58.
    U.S. Department of Health and Human Services. Current estimates from the national health interview survey, 1993 (DHHS Publication No. 95-1518). Hyattsville, MD: Public Health Service, Centers for Disease Control, National Center for Health Statistics; 1994.Google Scholar
  59. 59.
    Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2007. MMWR. 2008;57:1221-1226.Google Scholar
  60. 60.
    Rigotti NA. The future of tobacco treatment in the health care system. Ann Intern Med. 2009;150:496-497.PubMedCrossRefGoogle Scholar
  61. 61.
    Steinberg MB, Schmelzer AC, Richardson DL, Foulds J. The case for treating tobacco dependence as a chronic disease. Ann Intern Med. 2008;148:554-556.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2012

Authors and Affiliations

  • Megan E Piper
    • 1
  • Timothy B Baker
    • 1
  • Robin Mermelstein
    • 2
  • Linda M Collins
    • 3
  • David L Fraser
    • 1
  • Douglas E Jorenby
    • 1
  • Stevens S Smith
    • 1
  • Bruce A Christiansen
    • 1
  • Tanya R Schlam
    • 1
  • Jessica W Cook
    • 1
  • Madeline Oguss
    • 1
  • Michael C Fiore
    • 1
  1. 1.Center for Tobacco Research and InterventionUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Institute for Health Research and PolicyUniversity of Illinois at ChicagoChicagoUSA
  3. 3.The Methodology CenterPennsylvania State UniversityState CollegeUSA

Personalised recommendations