title: Including smoking status as a new vital sign: it works!
abstract: BACKGROUND
  Despite the adverse health consequences of smoking, many physicians still neglect to counsel smokers to quit. This study evaluated the effect of including smoking status as a vital sign on the frequency of physician discussions with patients about smoking and physician advice to quit smoking.
  
  
  METHODS
  A consecutive sample of adult ambulatory patients in our metropolitan family practice residency program completed exit surveys on physician and nurse counseling about smoking. Control group data were collected for 1 month before the change was made to include smoking status as a vital sign on patient charts. Charts were then marked with a stamp as a chart prompt in the vital signs section. Data were collected for 2 months after smoking status was added to the stamp.
  
  
  RESULTS
  There were 637 individuals surveyed, of whom 179 were current smokers; 95 in the "prestamp" group and 84 in the "poststamp" group. The percentage of patient-physician encounters during which smoking was discussed increased from 47% to 86% (P < .001). Physician advice to quit increased from 50% to 80% (P < .001). Physician discussion of smoking with patients increased across all of the five stages of change but most dramatically (53% to 95%) in the "preparation" stage. Physicians were much less likely to counsel patients in the "precontemplation" stage to quit smoking.
  
  
  CONCLUSIONS
  Including smoking as a new vital sign significantly increased the likelihood of smoking-related discussions between patients and their physicians. The stamp is inexpensive and easy to use, and because it is a one-time office system change, it is more likely to be implemented and maintained in busy practices.
authors.affiliation: Department of Family Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Robinson
authors.forename: S L
authors.initials: SL
authors.lastname: Laurent
authors.forename: J M
authors.initials: JM
authors.lastname: Little
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003376:Counseling; D005194:Family Practice; D006801:Humans; D011216:Practice Management, Medical; D011314:Preventive Health Services; D011446:Prospective Studies; D011996:Records; D017010:Reminder Systems; D012907:Smoking; D016540:Smoking Cessation