title: Smoking as a vital sign: prompts to ask and assess increase cessation counseling.
abstract: BACKGROUND
  Strategies to improve smoking cessation counseling in clinical settings are critical to supporting smokers' attempts to quit. This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification, assessment, and counseling for patients who smoke: "Current smoker?" and "Plan to quit?"
  
  
  METHODS
  Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics.
  
  
  RESULTS
  From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P<.001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P<.005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P=.41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P<.001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095-0.456).
  
  
  CONCLUSIONS
  Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling.
authors.affiliation: Nicotine Dependence Program, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7595, USA. annamc@unc.edu
authors.forename: Anna
authors.initials: A
authors.lastname: McCullough
authors.forename: Michael
authors.initials: M
authors.lastname: Fisher
authors.forename: Adam O
authors.initials: AO
authors.lastname: Goldstein
authors.forename: Kathryn D
authors.initials: KD
authors.lastname: Kramer
authors.forename: Carol
authors.initials: C
authors.lastname: Ripley-Moffitt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D055815:Young Adult