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DRUG, ALCOHOL, and SUBSTANCE ABUSE

A Method for Educating Patients and Documenting Smoking Status in an Electronic Medical Record

Associate Professor, Clinical Pharmacy and Outcome Sciences/Family Medicine; Associate Director, Graduate Pharmacy Education, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, SC

Sarah P Shrader, PharmD BCPS CDE

Assistant Professor, Clinical Pharmacy and Outcome Sciences/Family Medicine, South Carolina College of Pharmacy, Medical University of South Carolina Campus

Reprints: Dr. Ragucci, South Carolina College of Pharmacy, Medical University of South Carolina Campus, 295 Calhoun St., MSC 192, Charleston, SC 29425, fax 843/792-0436, raguccik{at}musc.edu

BACKGROUND: Published evidence demonstrates benefit from pharmacist smoking cessation interventions; however, there is limited research evaluating the impact of a template within an electronic medical record used at pharmacy disease state management visits.

OBJECTIVE: To determine the rates of smoking cessation and movement along the transtheoretical model of change after implementation of a template into existing pharmacy-related progress notes within the electronic medical record.

METHODS: Patients who were routinely followed by clinical pharmacists for anticoagulation and diabetes mellitus education at 3 clinics at the Medical University of South Carolina were included. At each visit, the pharmacist would document patient smoking information in a newly designed template within the existing progress note. In addition, pharmacists would educate patients on the benefits of smoking cessation and pharmacologic options that may be available to them. Data were collected between April 2007 and March 2008. Baseline demographic data and smoking cessation rates and products were compared using descriptive statistics. The McNemar ² test was used to compare the groups of patients achieving smoking cessation pre- and postintervention.

RESULTS: Of the 90 current smokers, 38 (42%) achieved smoking cessation postintervention. Movement along the transtheoretical model of change was also seen, with 52 (58%) patients progressing to at least the next stage. Thirty-four patients in the contemplation/preparation stage and 4 patients in the precontemplation stage moved to the action or maintenance stage by the end of the study period (p = 0.03). A variety of pharmacologic therapies were used in individuals who stopped smoking, although varenicline was most common. Thirty-nine percent of the patients used no medications to achieve cessation.

CONCLUSIONS: Incorporating a smoking cessation template into existing progress notes and providing education during existing pharmacy referral visits is a simple and effective method to assist patients in achieving smoking cessation.

Key Words: education, electronic medical record, pharmacy, smoking cessation, template, transtheoretical

Published Online, September 8, 2009. www.theannals.com, DOI 10.1345/aph.1M301