The implementation of a tobacco use registry in an academic family practice

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.

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.

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.

The tobacco use decision support tool resulted in an increase in provider confidence in prescribing cessation medications without lengthening the duration of patients' visits, and the tool continues to be used routinely in the practice 2 years after introduction, indicating sustainability. The use of a tobacco use registry and decision support tool aids in standardizing care and overcoming barriers to cessation counseling.