Introduction: Tobacco use is a significant risk factor for periodontal disease and oral cancer. However, previous research suggests that delivery of evidence-based tobacco cessation by dental providers is suboptimal. Providers report lacking confidence and knowledge, sufficient training or preparation, and time.
To address these issues, the purpose of this study was to create an evidence-based tobacco cessation clinical decision support tool embedded within the health history of the electronic dental record (EDR). This presentation reports on utilization of this tool by dental providers.
Methods: The tobacco section of the health history was modified to contain items designed to measure 1) level of dependency; 2) interest in quitting and 3) previous quit attempts. This information was then used to develop a series of evidence-based scripts to assist the dental provider in discussing/supporting tobacco cessation. Script usage was recorded by the provider creating a tobacco cessation counseling history. Use of the tool (i.e., screening, messaging, and documentation) was designed to be conducted in fewer than 3 minutes. The results presented are drawn from tool use as documented by the providers in 7 intervention clinics.
Results: Of the 385 tobacco-using patients who had encounters in intervention clinics during the study period, 276 (72%) had one or more scripts marked as used by a dental provider. The modal number of scripts used was 2 with a value of 48% of encounters. Altogether across all the encounters there were 815 scripts used. Of the 7 clinics involved in the intervention, script usage went from a low of 34% to a high of 96% (p<0.0001). There was no difference in script usage by gender (70% Males; 72% females; p=0.761). However, there was a clear decline in script usage by age with 18 to 29 year old tobacco users having scripts used 80% of the time verses 60 to 69 year olds having scripts used 66% of the time (p=0.0053). There was no variation in script usage relative to daily cigarette usage, dependency level, previous quit attempts or interest in quitting.
Conclusions: A computer-assisted tool incorporated within the electronic dental record can be designed to provide assistance to dental providers in tobacco cessation counseling. If the system is carefully developed, with the needs of the providers considered, the evidence from this study suggests that it will be used.