Can general practitioners use smoking status data in electronic health records to recruit patients for lung cancer...

In 2025, lung cancer screening commenced in Australia, with general practitioners (GPs) being patients' first point of contact to access the program. However, there is a gap in understanding how GPs can effectively identify screening-eligible individuals. Therefore, our study examined how smoking status data are recorded in GPs' electronic health records (EHRs), describing differences in smoking status data by socio-demographic characteristics and co-morbidities, and identifying missing data in EHRs.

A cross-sectional study was conducted. We investigated 1,366,586 adult patients regularly attending general practices in the MedicineInsight database, between 1 July 2021 and 30 June 2022. We assessed patient-related information as proportions, including currently recorded smoking status, socio-demographic characteristics, co-morbidities, and the number of cigarettes smoked per day amongst patients with a recorded smoking status.

In our study, 156,881 (11.5%) were recorded as patients who currently smoke, 311,503 (22.8%) as patients who formerly smoked, 766,091 (56.1%) as patients who never smoked, and 132,111 (9.7%) patients did not have smoking status recorded. Smoking status data was better recorded in older age groups, including the lung cancer screening age-eligible population of 50-70-year-olds. Lower socio-economic areas and remote/ very remote areas had higher rates of patients who currently and formerly smoked. Co-morbidities such as chronic obstructive pulmonary disease, diabetes and cardiovascular disease had higher numbers of patients who currently and formerly smoked, compared to patients who never smoked. EHR recording of cigarettes smoked per day were limited to only 759 patients with a recorded smoking status.

Our study indicates that smoking status was recorded in EHRs for over 90% of regularly attending adult patients during the study period. Whilst GPs can use smoking status in EHRs to help identify potential patients for LCS, GPs will need to further assess these patients for screening eligibility, as detailed smoking history data were poorly recorded in EHRs. Priority populations for GPs include those from lower socio-economic and remote/ very remote areas, and those with certain co-morbidities.