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Use of electronic health records to support smoking cessation

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Abstract

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Background

Health information systems such as electronic health records (EHR), computerized decision support systems, and electronic prescribing are potentially valuable components to improve the quality and efficiency of clinical interventions for tobacco use.

Objectives

To assess the effectiveness of electronic health record‐facilitated interventions on smoking cessation support actions by clinicians and on patient smoking cessation outcomes.

Search methods

We searched the Cochrane Tobacco Addiction Group Specialised Register, CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, and reference lists and bibliographies of included studies. We searched for studies published between January 1990 and May 2011.

Selection criteria

We included both randomized studies and non‐randomized studies that reported interventions targeting tobacco use through an EHR in health care settings. The intervention could include any use of an EHR to improve smoking status documentation or cessation assistance for patients who use tobacco, either by direct action or by feedback of clinical performance measures.

Data collection and analysis

Characteristics and content of the interventions, participants, outcomes and methods of the included studies were extracted by one author and checked by a second. Because few randomized studies existed, we did not conduct a meta‐analysis.

Main results

We included three randomized and eight non‐randomized observational studies of fair to good quality that tested the use of an existing EHR to improve documentation and/or treatment of tobacco use. None of the studies included a direct assessment of patient quit rates. Overall, these studies found only modest improvements in some of the recommended clinician actions steps on tobacco use.

Authors' conclusions

At least in the short term, documentation of tobacco status and increased referral to cessation counseling do appear to increase following the introduction of an expectation to use the EHR to record and treat patient tobacco use at medical visits. There is a need for additional research to further understand the effect of EHRs on smoking treatment in healthcare settings.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Does use of an electronic health record to enhance the delivery of effective tobacco cessation treatment to patients using tobacco accomplish that?

In many countries a large investment is being made in technology to computerize patient medical records. One potential of electronic health records (EHR) is that they could be used to remind clinicians to record tobacco use, to give brief advice to quit, to prescribe medications and to refer to cessation counseling. They could also facilitate those referrals and performance measures with feedback. We included 11 studies in this review, but most were observational studies. Of the recommended actions for clinicians with tobacco using patients we found only modest improvements in recommended clinician actions for tobacco users associated with the EHR changes.  While documentation of tobacco use and referral to cessation counseling appear to increase, patient smoking cessation was not demonstrated.