Merianos Ashley L, Fiser Kayleigh, Mahabee-Gittens E Melinda, Lyons Michael S, Stone Lara, Gordon Judith S
University of Cincinnati, School of Human Services, PO Box 210068, Cincinnati, OH, 45221-0068, United States.
University of Cincinnati, College of Medicine, Center for Addiction Research, Cincinnati, OH, United States.
Drug Alcohol Depend Rep. 2021 Dec 11;2:100019. doi: 10.1016/j.dadr.2021.100019. eCollection 2022 Mar.
Clinical Decision Support Systems (CDSS) embedded into electronic medical records is a best practices approach. However, information is needed on how to incorporate a CDSS to facilitate parental tobacco cessation counseling and reduce child tobacco smoke exposure (TSE) in Pediatric Emergency Department (PED) and Urgent Care (UC) settings. The objective was to explore the barriers and enablers of CDSS use to facilitate child TSE screening and parental tobacco cessation counseling by PED/UC nurses and physicians.
We conducted 29 semi-structured, focused interviews with nurses ( = 17) and physicians ( = 12) at a children's hospital PED/UC. The interview guide included a brief presentation about the design and components of a prior CDSS tobacco intervention. Participants were asked their opinions about CDSS components and recommendations for adapting and implementing the CDSS tobacco intervention in the PED/UC setting. A thematic framework analysis method was used to code and analyze qualitative data.
Participant mean (± SD) age was 42 (± 10.1) years; the majority were female (82.8%), non-Hispanic white (93.1%), and never tobacco users (86.2%); all were never electronic cigarette users. Four themes emerged: (1) explore optimal timing to complete CDSS screening and counseling during visits; (2) CDSS additional information and feedback needs; (3) perceived enablers to CDSS use, such as the systematic approach; and (4) perceived barriers to CDSS use, such as lack of time and staff.
The CDSS intervention for child TSE screening and parental tobacco cessation during PED/UC visits received endorsements and suggestions for optimal implementation from nurses and physicians.
嵌入电子病历的临床决策支持系统（CDSS）是一种最佳实践方法。然而，在儿科急诊科（PED）和紧急护理（UC）环境中，需要有关如何纳入CDSS以促进家长戒烟咨询并减少儿童烟草烟雾暴露（TSE）的信息。目的是探讨CDSS使用的障碍和促进因素，以便利PED/UC护士和医生进行儿童TSE筛查和家长戒烟咨询。
我们在一家儿童医院的PED/UC对护士（n = 17）和医生（n = 12）进行了29次半结构化、聚焦式访谈。访谈指南包括对先前CDSS烟草干预措施的设计和组成部分的简要介绍。询问参与者对CDSS组成部分的看法以及在PED/UC环境中调整和实施CDSS烟草干预措施的建议。采用主题框架分析方法对定性数据进行编码和分析。
参与者的平均（±标准差）年龄为42（±10.1）岁；大多数为女性（82.8%）、非西班牙裔白人（93.1%）且从不吸烟（86.2%）；所有人都从不使用电子烟。出现了四个主题：（1）探索在就诊期间完成CDSS筛查和咨询的最佳时机；（2）CDSS的额外信息和反馈需求；（3）对CDSS使用的感知促进因素，如系统方法；（4）对CDSS使用的感知障碍，如时间和人员不足。
在PED/UC就诊期间用于儿童TSE筛查和家长戒烟的CDSS干预措施得到了护士和医生的认可以及关于最佳实施的建议。
