Smoking status assessment is the first step for treating smokers with chronic illness. Various studies have shown that physicians take an active role in advising smokers to quit in general population. Few studies are found relating smoking assessment and documentation on patients with chronic diseases. The objective of this study is to identify the gap between physicians' perception and their practice on smoking status assessment & documentation for patients with chronic illness.
A survey of 1,803 primary care physicians (PCP) was conducted in 2000 to assess physicians awareness and application of the National Cancer Institute's 4 A's model (Ask, Advise, Assist, Arrange). A 50.4% response rate achieved. The results: PCPs have a high rate of asking (76%) and advising (92%) their patients who smoke to quit. At the same time, a random sample of 1,572 medical record review was conducted for patients with chronic illness (CAD - 572, CHF - 225, Diabetes - 775). The results: 53% records document smoking status. There is a gap between PCPs' self-reported data and record documentation. Further analyses indicated that only 22.3% PCPs use a formal tracking system to document patient smoking status (12% a vital sign stamp, 5.7% tobacco-use stickers, and 4.6% computerized tracking system). The rest include smoking status information into routine assessment/progress notes (52.7%) or no documentation at all (25%).
Recommendations are to promote physician education on 4 A's model for patients who smoke and to establish a formal tracking system (e.g. a vital sign stamp) in the practice.
See www.tufts-health.comLearning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: 1.Identify the gap between physicians' perception and their practice on smoking status assessment & documentation 2.Articulate the factors associated with the gap; 3.Develop an improvement strategy for physicians to use in order to reduce the gap and enhance smoking assessment tracking system.
Keywords: Smoking Cessation, Physicians
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Tufts Health Plan
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employment