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An Integrated Computer-Based System for Treating Tobacco Dependence in a
The investigators developed, implemented and tested an integrated computer-based system for tobacco user identification and smoking cessation intervention for primary care patients in a medically-indigent, managed care population. The goal was to improve identification of tobacco users and increase provider cessation intervention rates for those patients at care visits. The target populations were enrollees of Wishard Advantage, a managed care program for the uninsured in the Indianapolis metropolitan area. An interactive voice response (IVR) system was programmed to call all Wishard Advantage patients scheduled for primary care visits at two community health centers affiliated with Wishard Health Services. Candidates were screened for tobacco use and readiness to quit through the automated telephone system using IVR technology. This information was then transferred to the Regenstrief Medical Records System (RMRS) to generate reminders to primary care providers for appropriate smoking cessation intervention. These reminders were tailored to each patient based on their answers to the IVR survey and included on the patient’s encounter forms for the clinic visit. System outcomes were assessed through patient exit interviews. The IVR system placed 2,039 calls resulting in 1086 (55%) patients completing the questionnaire and 421 (39%) indicating current smoking status. Of the 421 smokers, 120 patients agreed to participate in the follow-up survey. Fifty-eight participants (48% of identified smokers) reported discussing smoking cessation with their provider. Thirtyfive participants reported being advised to quit smoking by their provider at that visit and 102 participants indicated that they had been advised to quit by a provider in the past. No significant relationship for outcome based on individual characteristics was found; however, younger participants were more likely to be asked to set a quit date by the provider (OR=0.92, p=0.01). Seventy-one percent of patients agreed that this format was a good way to give providers information about their health. Using IVR technology to capture patient-reported data is a promising strategy for screening for tobacco use in primary care. Citation: McDaniel AM, Benson PL, Roesener GH, Martindale J. An integrated computer-based system to support nicotine dependence treatment in primary care. Nicotine & Tobacco Research 2005; 7 (Suppl 1): S57-S66. For more information, contact: Anna M. McDaniel, DNS, RN
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