title: Impact of vital signs screening & clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison.
abstract: BACKGROUND
  Though screening and intervention for alcohol and tobacco misuse are effective, primary care screening and intervention rates remain low. Previous studies have increased intervention rates using vital signs screening for tobacco misuse and clinician prompts for screen-positive patients for both alcohol and tobacco misuse. This pilot study's aims were: (1) To determine the feasibility of combined vital signs screening for tobacco and alcohol misuse, (2) To assess the impact of vital signs screening on alcohol and tobacco screening and intervention rates, and (3) To assess the additional impact of tobacco assessment prompts on intervention rates.
  
  
  METHODS
  In five outpatient practices, nurses measuring vital signs were trained to routinely ask a single tobacco question, a prescreening question that identified current drinkers, and the single alcohol screening question for current drinkers. After 4-8 weeks, clinicians were trained in tobacco intervention and nurses were trained to give tobacco abusers a tobacco questionnaire which also served as a clinician intervention prompt. Screening and intervention rates were measured using patient exit interviews (n = 622) at baseline, during the "screening only" period, and during the tobacco prompting phase. Changes in screening and intervention rates were compared using chi square analyses and test of linear trends. Clinic staff were interviewed regarding patient and staff acceptability. Logistic regression was used to evaluate the impact of nurse screening on clinician intervention, the impact of alcohol intervention on concurrent tobacco intervention, and the impact of tobacco intervention on concurrent alcohol intervention.
  
  
  RESULTS
  Alcohol and tobacco screening rates and alcohol intervention rates increased after implementing vital signs screening (p < .05). During the tobacco prompting phase, clinician intervention rates increased significantly for both alcohol (12.4%, p < .001) and tobacco (47.4%, p = .042). Screening by nurses was associated with clinician advice to reduce alcohol use (OR 13.1; 95% CI 6.2-27.6) and tobacco use (OR 2.6; 95% CI 1.3-5.2). Acceptability was high with nurses and patients.
  
  
  CONCLUSIONS
  Vital signs screening can be incorporated in primary care and increases alcohol screening and intervention rates. Tobacco assessment prompts increase both alcohol and tobacco interventions. These simple interventions show promise for dissemination in primary care settings.
authors.affiliation: Department of Family Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, 3780 Eisenhower Pkwy, Macon, GA 31206, USA. seale.paul@mccg.org
authors.forename: J Paul
authors.initials: JP
authors.lastname: Seale
authors.forename: Sylvia
authors.initials: S
authors.lastname: Shellenberger
authors.forename: Mary M
authors.initials: MM
authors.lastname: Velasquez
authors.forename: John M
authors.initials: JM
authors.lastname: Boltri
authors.forename: Ike
authors.initials: I
authors.lastname: Okosun
authors.forename: Monique
authors.initials: M
authors.lastname: Guyinn
authors.forename: Dan
authors.initials: D
authors.lastname: Vinson
authors.forename: Monica
authors.initials: M
authors.lastname: Cornelius
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis*; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008503:Medical Staff / Q000193:education; D008875:Middle Aged; D036301:Qualitative Research; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000175:diagnosis*; D055986:Vital Signs