title: Computer-assisted guidance for dental office tobacco-cessation counseling: a randomized controlled trial.
abstract: BACKGROUND
  Decreases in smoking prevalence from recent decades have slowed, and national goals to reduce tobacco use remain unmet. Healthcare providers, including those in physician and dental teams, have access to evidence-based guidelines to help patients quit smoking. Translation of those guidelines into practice, however, remains low. Approaches that involve screening for drug use, brief intervention, and referral to treatment (SBIRT) are a promising, practical solution.
  
  
  OBJECTIVE
  This study examined whether dentists and dental hygienists would assess interest in quitting, deliver a brief tobacco intervention, and refer to a tobacco quitline more frequently as reported by patients if given computer-assisted guidance in an electronic patient record versus a control group providing usual care.
  
  
  METHODS
  A blocked, group-randomized trial was conducted from November 2010 to April 2011. Randomization was conducted at the clinic level. Patients nested within clinics represented the lowest-level unit of observation.
  
  
  METHODS
  Participants were patients in HealthPartners dental clinics.
  
  
  METHODS
  Intervention clinics were given a computer-assisted tool that suggested scripts for patient discussions. Usual care clinics provided care without the tool.
  
  
  METHODS
  Primary outcomes were post-appointment patient reports of the provider assessing interest in quitting, delivering a brief intervention, and referring them to a quitline.
  
  
  RESULTS
  Patient telephone surveys (72% response rate) indicated that providers assessed interest in quitting (control 70% vs intervention 87%, p=0.0006); discussed specific strategies for quitting (control 26% vs intervention 47%, p=0.003); and referred the patient to a tobacco quitline (control 17% vs intervention 37%, p=0.007) more frequently with the support of a computer-assisted tool integrated into the electronic health record.
  
  
  CONCLUSIONS
  Clinical decision support embedded in electronic health records can effectively help providers deliver tobacco interventions. These results build on evidence in medical settings supporting this approach to improve provider-delivered tobacco cessation.
  
  
  BACKGROUND
  This study is registered at ClinicalTrials.govNCT01584882.
authors: HealthPartners Institute for Education and Research, Minneapolis, MN 55425, USA. Donald.b.rindal@healthpartners.com
authors: D Brad
authors: DB
authors: Rindal
authors: William A
authors: WA
authors: Rush
authors: Titus K L
authors: TK
authors: Schleyer
authors: Michael
authors: M
authors: Kirshner
authors: Raymond G
authors: RG
authors: Boyle
authors: Merry Jo
authors: MJ
authors: Thoele
authors: Stephen E
authors: SE
authors: Asche
authors: Thankam
authors: T
authors: Thyvalikakath
authors: Heiko
authors: H
authors: Spallek
authors: Emily C U
authors: EC
authors: Durand
authors: Chris J
authors: CJ
authors: Enstad
authors: Charles L
authors: CL
authors: Huntley
mesh_terms: D000328:Adult; D003142:Communication; D003376:Counseling; D020000:Decision Support Systems, Clinical; D003756:Dental Hygienists; D003770:Dental Offices / Q000458:organization & administration*; D003815:Dentists; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation / Q000379:methods*