Effectiveness of computer-assisted guidance for tobacco dependence in dental offices
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Tobacco use is an etiologic factor for multiple diseases, including periodontal disease and oral cancers. Current evidence suggests dental providers ask about tobacco use but don't assist the patient in tobacco cessation. Approaches that involve Screening for drug use, Brief Intervention, and Referral to Treatment (SBIRT) provide a promising, practical solution. This project examines whether dentists and hygienists will assess interest in quitting, deliver a brief tobacco intervention and refer to a tobacco quitline more frequently when provided with computer assisted guidance compared to a control group.
This study is a blocked, group-randomized trial in which the HPDG dental clinics are the unit of randomization and patients nested within each randomized clinic represent the lowest level unit of observation.
All clinics assess tobacco use including type and amount, dependency questions and interest in quitting. The intervention clinics included the intervention that provided suggested scripts for the provider to use based on dependency, prior attempts and interest in quitting. Primary outcomes were patient reports of the provider assessing interest in quitting, delivering a brief intervention and referring to a quitline. The outcome measure came from a random sample of smokers surveyed by phone 1-3 days after the dental appointment. Electronic data recorded by providers in the electronic dental record was also examined.
Dental providers assessed interest in quitting (control 71% vs. intervention 89%; p=.0001), discussed specific strategies for quitting (control 25% vs. intervention 48%; p=.003) and referred the patient to a tobacco quitline (control 17% vs. intervention 39%; p=.007).
Computer tools embedded within electronic health records can effectively assist providers in the delivery of tobacco interventions. This tool was developed with user-centered design principles increasing the likelihood of adoption by providers. This approach holds promise for translating current evidence into daily clinical practice.