Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting

Abstract

Objectives: To determine rates of patient reported and physician documented counselling; to identify predictors of each report; and to identify the impact of each report on smoking cessation attempts after discharge from the hospital.

Design: Stickers on subjects' charts prompted physicians to give brief smoking cessation counselling to patients in the hospital. Patients reported counselling received and quit attempts in a phone interview conducted 7-18 days after discharge. Rates of counselling and correlations were calculated, and multivariate analysis identified predictors of patient report, physician documentation, and quit attempts.

Setting: Four hospitals in the Minneapolis/St Paul metropolitan area.

Subjects: 682 hospital patients who had smoked more than 100 cigarettes in their lifetime and had smoked in the last three months.

Results: 71.0% of patients reported counselling, and physicians documented counselling in the charts of 46.2% of patients (correlation = 0.15, kappa = 0.13). Patient report was predicted by specific hospital, belief that their hospitalisation was smoking related, diagnosis of a smoking related disease, and physician documentation of counselling. Physician documentation was predicted by female patient, specific hospital, longer hospital stay, and marginally predicted by smoking related disease. Quit attempts were predicted by patient report of counselling, but not physician documentation.

Conclusions: Physicians document counselling in the hospital at a lower rate than patients report it, and the correlation between reports is very low, making an accurate assessment of true rates of counselling difficult. While it is important to increase physician documentation, it is even more important to increase patient recall, as this is the only report that predicts a quit attempt.