Promoting Tobacco Cessation in a Rural North Dakota Primary Care Clinic

• Main Author: Mueller, Taylor
• Format: Others
• Published: North Dakota State University 2019
• Online Access: https://hdl.handle.net/10365/29520

Tobacco use is a monumental public health problem in the United States; 15 % of American adults report using tobacco products. Tobacco negatively affects the health of individuals, families, communities, and the environment. Primary care providers (PCPs) interact with more than 80% of tobacco users yearly, as such, can play a pivotal role in promoting tobacco cessation. The American Academy of Family Physicians Treating Tobacco Dependence Manual provided the blueprint for the project development and design. The project objectives included: 1) create an environment that promotes a tobacco-free culture, 2) improve the approach to tobacco cessation counseling using the Ask, Advise, and Refer approach, and 3) simplify provider documentation of patient tobacco use, counseling, and referral. The project took place in a rural primary care clinic over eight-weeks. Prior to implementation, clinic staff and providers were educated on project objectives and the Ask, Advise, Refer behavioral intervention approach. An environmental assessment of the clinic indicated that a tobacco-free culture would require environmental changes. In the second phase, tobacco users completed a tobacco inventory (Ask), which prompted providers to Advise about tobacco cessation, and Refer interested tobacco users to NDQuits. To simplify provider documentation of patient tobacco use, interest in cessation, and referral, two dot phrases were created and integrated in the clinic electronic medical record (EHR). The project objectives were met. The clinic environment was altered to reflect the desired tobacco free culture by the addition of tobacco cessation messages in the form of posters, signs, brochures, and tear-off sheets. Twenty-one tobacco users completed the tobacco inventory, 20 reported an interest in cessation, and seven participants were referred to NDQuits. One of the seven participants reported successful tobacco cessation. Providers felt that documentation was simplified with EHR integration of dot phrases. Tobacco use is the leading cause of death and disease in adults over age 18. The United States Public Health Services (USPHS) recommends that every patient who smokes is acknowledged, advised to quit, and is provided with evidence-based treatment by every healthcare provider at every visit.