Persistence of smoking-cessation decision support use in a dental practice.
BACKGROUND
A computer-assisted tobacco decision support tool increased dental practitioners' (dentists and dental hygienists) advice to quit smoking and referral to a quitline during a group randomized trial. The purpose of this study is to document the extent to which use persisted after the trial.


METHODS
Electronic dental record (EDR) data from 2010 to 2013 were analyzed in 2014 for use of computer-assisted tobacco intervention tool advice scripts and referral to a quitline during four periods: during the trial and post-trial when only intervention clinic dental practitioners had access to the tool, and during full deployment, both before and after an EDR modification.


RESULTS
Intervention clinic dental practitioners (18.5 dentist full-time equivalents [FTEs] and 27.8 dental hygienist FTEs practicing in seven clinics) referred 19.0% of 1,368 smokers to a quitline during the trial and referred 15.4% of 4,011 smokers post-trial. After full tool deployment but pre-EDR change, these dental practitioners referred 15.6% of 2,214 intervention clinic smokers, whereas 18.3 dentist FTEs and 29.7 dental hygienist FTEs practicing in eight clinics referred 8.5% of 2,113 smokers. Post-EDR change, dental practitioners referred 12.2% of 2,214 intervention clinic smokers and 8.1% of 2,399 control clinic smokers to a quitline. In the last three quarters of observation, clinic script use ranged from 15.4% to 65.8% and referral to a quitline ranged from 2.0% to 18.7% of visits.


CONCLUSIONS
Although EDR design affected rates of referral, dental practitioners persisted in using a computer-assisted tobacco intervention tool to refer smokers to a quitline.
HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Electronic address: thomas.e.kottke@healthpartners.com.
Thomas E
TE
Kottke
HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
D
D
Brad Rindal
HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
William A
WA
Rush
HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
Stephen E
SE
Asche
HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
Chris J
CJ
Enstad
D003661:Decision Support Techniques; D003756:Dental Hygienists / Q000706:statistics & numerical data*; D003815:Dentists / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D015277:Hotlines / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012017:Referral and Consultation; D016540:Smoking Cessation; D013813:Therapy, Computer-Assisted