DESCRIPTION (provided by applicant): Tobacco use is the most common cause of preventable death and disease. While most of the reductions in mortality from tobacco in the near future will be achieved through helping current users to quit, habitual smokers find it extremely difficult to successfully stop smoking. The evidence-based United States Public Health Service Guideline on the treatment of tobacco use and dependence (USPHS Guideline) recommends that physicians identify their patients' smoking status, advise those that smoke to quit, assist them in their quit attempts, and follow up on these attempts. Unfortunately, physicians identify only about half of current smokers, advise less than half, and recommend cessation resources only to a small minority of these patients. Our approach to this problem has been to develop with physicians and clinic staff a decision support system that reminds the physician to perform the guideline, and assists physicians in counseling patients who smoke cigarettes. The system was developed on a personal digital assistant (SC-PDA) for use in the exam room and guides the physician in developing patient-specific recommendations including information on available counseling resources and pharmacotherapy. A server networked to the SC-PDA then generates a tailored printed handout for the patient, and documentation to support billing for this intervention. We have recently completed testing the feasibility of implementing and using this SC-PDA in two primary care clinics. We are now ready to do pilot testing of it's impact on physician adherence to the USPHS guideline, and on patient quit behavior using a clustered cross sectional pre-test post-test design to test the hypothesis that the SC-PDA will improve the rate at which physicians assist their patients with smoking cessation, and assess whether exposure to information and recommendations from the SC-PDA will increase the rate at which patients make at least one serious quit attempt in the month following the physician visit, and increase the use of counseling and pharmacotherapy during those attempts. These data, if promising, would provide the basis for proposing a cluster randomized controlled trial of the SC-PDA as a more robust test of our hypotheses. PUBLIC HEALTH RELEVANCE: This translational research project evaluates whether a decision support system on a personal digital assistant enhances physician tobacco-use brief interventions, a preventive service that is known to reduce smoking - the most common cause of preventable death in the U.S.
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