Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record

Abstract

Almost 35 million U.S. smokers visit primary care clinics annually, creating a need and opportunity to identify such smokers and engage them in evidence-based smoking treatment. The purpose of this study is to examine the feasibility and effectiveness of a chronic care model of treating tobacco dependence when it is integrated into primary care systems using electronic health records (EHRs). The EHR prompted primary care clinic staff to invite patients who smoked to participate in a tobacco treatment program. Patients who accepted and were eligible were offered smoking reduction or cessation treatment. More than 65 % of smokers were invited to participate, and 12.4 % of all smokers enrolled in treatment-30 % in smoking reduction and 70 % in cessation treatment. The chronic care model developed for treating tobacco dependence, integrated into the primary care system through the EHR, has the potential to engage up to 4.3 million smokers in treatment a year.

Keywords: Chronic care smoking treatment; Electronic health record; Primary care; Recruitment; Smoking cessation; Translational research.

Figures

Fig 1

Referral script for medical assistants to read to all smokers

Fig 2

Flow of patients into study referral as of December, 2011. Note. Initial decline = participant declined to hear more about the study and did not complete a phone screen

Fig 3

Study flow into the three research studies as of December, 2011, based on a phone screen question asking if the patient would like to quit smoking in the next 30 days (first treatment selection script). Note. Enrolled means the patient attended the first study visit

Fig 4

Study flow into the three research studies as of December, 2011, based on asking patients during the phone screen to choose between a study for smokers who are ready to quit in the next month and a study for smokers who are interested in cutting down (second treatment selection script). Note. Enrolled means the patient attended the first study visit. Screen Passed Thus Far means the patient passed the phone screen but has not yet attended the first study visit