Conroy Molly B, Majchrzak Nicola E, Silverman Caroline B, Chang Yuchiao, Regan Susan, Schneider Louise I, Rigotti Nancy A
Division of General Internal Medicine, University of Pittsburgh, PA, USA.
Nicotine Tob Res. 2005 Apr;7 Suppl 1:S35-43. doi: 10.1080/14622200500078089.
An accurate method of measuring primary care providers' tobacco counseling actions is needed for monitoring adherence to clinical practice guidelines. We compared three methods of measuring providers' tobacco counseling practices: electronic medical record (EMR) review, patient survey, and provider survey. We mailed a survey to 1,613 smokers seen by 114 Boston-area primary care providers during a 2-month period to assess what tobacco counseling actions had occurred at the visit (N = 766; 47% response rate). Smokers' reports were compared with the EMR and with their providers' self-reported usual tobacco counseling practices, derived from a provider survey (N = 110; 96% response rate). Patients reported receiving each counseling action more frequently than providers documented it in the EMR. Agreement between the patient survey and the EMR was poor for all 5A steps (kappa statistic = 0.01-0.22). Providers reported that they often or always performed each 5A action at a higher rate than indicated by EMR or patient report. However, providers who said they often or always performed individual 5A steps did not have consistently higher mean rates of EMR documentation or patient report than those who said they performed the 5A's less frequently. Little agreement was found among the three methods of measuring primary care providers' tobacco counseling actions. Implementing an EMR does not necessarily improve providers' documentation of tobacco interventions, but EMR adaptations that would standardize provider documentation of tobacco counseling might make the EMR a more reliable tool for monitoring providers' delivery of tobacco treatment services.
为监测临床实践指南的遵守情况，需要一种准确测量初级保健提供者烟草咨询行为的方法。我们比较了三种测量提供者烟草咨询实践的方法：电子病历（EMR）审查、患者调查和提供者调查。我们向114名波士顿地区初级保健提供者在2个月期间接诊的1613名吸烟者邮寄了一份调查问卷，以评估就诊时发生了哪些烟草咨询行为（N = 766；回复率47%）。将吸烟者的报告与电子病历以及他们的提供者自我报告的通常烟草咨询实践进行比较，后者来自提供者调查（N = 110；回复率96%）。患者报告接受每种咨询行为的频率高于提供者在电子病历中的记录。在所有5A步骤中，患者调查与电子病历之间的一致性较差（kappa统计量 = 0.01 - 0.22）。提供者报告称，他们经常或总是执行每项5A行动的比例高于电子病历或患者报告所显示的比例。然而，那些表示经常或总是执行个别5A步骤的提供者，其电子病历记录或患者报告的平均比例并不始终高于那些表示执行5A步骤频率较低的提供者。在测量初级保健提供者烟草咨询行为的三种方法之间几乎没有发现一致性。实施电子病历不一定能改善提供者对烟草干预措施的记录，但对电子病历进行调整以使提供者对烟草咨询的记录标准化，可能会使电子病历成为监测提供者提供烟草治疗服务的更可靠工具。
