Limited evidence for the use of electronic health records to improve smoking cessation rates

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This Cochrane systematic review examined the effectiveness of electronic health record-facilitated interventions on smoking cessation activity by clinicians and on patient smoking cessation outcomes. The review shows these interventions improve the documentation of tobacco use and referral to cessation counselling, but does not demonstrate an improvement in patients actually giving up smoking.

While smoking rates have declined in many developed countries there are still large numbers of people dying from smoking-related diseases each year. The health care setting remains an underused venue to provide cessation assistance to tobacco users. Evidence-based clinical practice guidelines for tobacco cessation support recommend systematic identification and intervention for tobacco use.

Parallel to this is the significant investment being made in electronic health records across the globe. One possible use for these systems is to act as a reminder to clinicians to record users smoking status; linking patients to cessation services, monitoring performance, and providing feedback. A system level change that might increase the frequency of effective cessation delivery is to take advantage of the electronic medical record for clinician reminders.

The systematic review found 3 randomised controlled trials (RCTs) and 8 observational studies that reported interventions targeting tobacco use through an electronic health record in health care settings (ten of the eleven studies were based in the USA and the other in Australia). Due to a lack of RCTs no meta-analysis was performed. Frustratingly, 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.

Overall, the authors concluded:

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

Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD008743. DOI: 10.1002/14651858.CD008743.pub2

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