Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Nicotine Tob Res. 2012 Jun;14(6):674-81. doi: 10.1093/ntr/ntr265. Epub 2011 Dec 16.
Tobacco cessation medication use increases the likelihood of a successful quit attempt, but few smokers are prescribed medications. Electronic health records (EHRs) may increase cessation medication prescription. This study aimed to assess the impact of an electronic alert and linked order set on cessation medication prescription.
This pre- and postintervention cohort study was conducted in an urban academic general internal medicine practice with a comprehensive EHR. All active smokers with 2 or more visits to the practice in 2008 (preintervention cohort) or 2009 (postintervention cohort) were included. An electronic alert and linked order set were designed and implemented. The primary outcome was prescription of any cessation medication (nicotine replacement therapy, bupropion, or varenicline). Secondary outcomes included counseling referral and change in smoking status to quit during the study period (i.e., "quit rate").
There were 1,349 and 1,346 smokers in the pre- and postintervention cohorts, respectively. Cessation medication prescription did not significantly change after the intervention (14.4% vs. 13.4% of smokers in the preintervention cohort, p = .5). Counseling referrals increased from 2.0% to 7.2% in the postintervention cohort (p < .001). More smokers in the postintervention cohort changed their smoking status to quit during the study period (20.5% vs. 17.1%, p = .06).
This provider-directed electronic alert and linked order set failed to increase cessation medication prescription. The consistent failure of provider-directed efforts to increase cessation medication use suggests that this is a patient-limited process. Future efforts to improve tobacco treatment should focus on overcoming patient-level barriers to cessation medication use.
使用戒烟药物可提高戒烟成功率，但很少有吸烟者开此类药物。电子健康记录（EHR）可能会增加戒烟药物的处方。本研究旨在评估电子警示和相关医嘱集对戒烟药物处方的影响。
这是一项在具有全面 EHR 的城市学术综合内科实践中进行的前后干预队列研究。所有在 2008 年（干预前队列）或 2009 年（干预后队列）就诊 2 次或以上的活跃吸烟者均被纳入研究。设计并实施了电子警示和相关医嘱集。主要结局是开任何戒烟药物（尼古丁替代疗法、安非他酮或伐尼克兰）的处方。次要结局包括在研究期间咨询转诊和吸烟状态改变为戒烟（即“戒烟率”）。
干预前和干预后队列分别有 1349 名和 1346 名吸烟者。干预后戒烟药物处方并未显著增加（干预前队列中 14.4%的吸烟者和干预后队列中 13.4%的吸烟者，p =.5）。咨询转诊从干预后队列的 2.0%增加到 7.2%（p <.001）。在干预后队列中，更多的吸烟者在研究期间改变了吸烟状态以戒烟（20.5% vs. 17.1%，p =.06）。
本研究中，这种由医生主导的电子警示和相关医嘱集并未增加戒烟药物的处方。由医生主导的增加戒烟药物使用的努力始终失败，这表明这是一个受患者限制的过程。未来改善烟草治疗的努力应集中于克服患者使用戒烟药物的障碍。
