title: Impact of an electronic alert and order set on smoking cessation medication prescription.
abstract: BACKGROUND
  Tobacco cessation medication use increases the likelihood of a successful quit attempt, but few smokers are prescribed medications. Electronic health records (EHRs) may increase cessation medication prescription. This study aimed to assess the impact of an electronic alert and linked order set on cessation medication prescription.
  
  
  METHODS
  This pre- and postintervention cohort study was conducted in an urban academic general internal medicine practice with a comprehensive EHR. All active smokers with 2 or more visits to the practice in 2008 (preintervention cohort) or 2009 (postintervention cohort) were included. An electronic alert and linked order set were designed and implemented. The primary outcome was prescription of any cessation medication (nicotine replacement therapy, bupropion, or varenicline). Secondary outcomes included counseling referral and change in smoking status to quit during the study period (i.e., "quit rate").
  
  
  RESULTS
  There were 1,349 and 1,346 smokers in the pre- and postintervention cohorts, respectively. Cessation medication prescription did not significantly change after the intervention (14.4% vs. 13.4% of smokers in the preintervention cohort, p = .5). Counseling referrals increased from 2.0% to 7.2% in the postintervention cohort (p < .001). More smokers in the postintervention cohort changed their smoking status to quit during the study period (20.5% vs. 17.1%, p = .06).
  
  
  CONCLUSIONS
  This provider-directed electronic alert and linked order set failed to increase cessation medication prescription. The consistent failure of provider-directed efforts to increase cessation medication use suggests that this is a patient-limited process. Future efforts to improve tobacco treatment should focus on overcoming patient-level barriers to cessation medication use.
authors.affiliation: Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. j-mathias@md.northwestern.edu
authors.forename: Jason S
authors.initials: JS
authors.lastname: Mathias
authors.forename: Aashish K
authors.initials: AK
authors.lastname: Didwania
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
mesh_terms: D016642:Bupropion / Q000627:therapeutic use; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012907:Smoking / Q000188:drug therapy; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D016642:Bupropion