Testing clinical decision support for treating tobacco use in dental clinics

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ABSTRACT Tobacco use is the most common cause of preventable death and disease. While most of the reductions in mortality from tobacco in the near future will be achieved through helping current users to quit, habitual smokers find it extremely difficult to successfully stop. The evidence-based United States Public Health Service Guideline on the treatment of tobacco use and dependence (PHS Guideline) recommends that all clinicians identify their patients' tobacco use status, advise those that smoke or use other forms of tobacco to quit, assist them in their quit attempts, and follow-up on these attempts. Dental public health clinics afford a unique and relatively untapped opportunity to help those patients most in need of smoking cessation services. Recognizing the importance of dentistry in tobacco control efforts, the newly released Healthy People 2020 includes, as a key objective, to improve screening and cessation counseling rates in dental care settings. Most smokers see a dentist annually and tobacco use is a known risk factor for oral disease. Moreover, controlled trials have demonstrated the efficacy of dental office-based brief cessation interventions. Unfortunately, dentists recommend cessation resources only to a small minority of their patients. Our approach to this problem has been to develop, with dentists and dental students, a decision support system that reminds the dentist to perform the guideline and assists them in counseling patients who use tobacco. The system was developed on a personal digital assistant (TC-PDA) for use in the exam room and guides the dentist in developing patient-specific recommendations including information on available counseling resources and pharmacotherapy. We have recently completed testing the feasibility of implementing and using this TC-PDA in one general dental clinic. We are now ready to do pilot testing of it's impact on dentists adherence to the PHS guideline, and on patient quit behavior using a cross sectional pre-test post-test design to test the hypothesis that the TC-PDA will improve the rate at which dentists and dental students assist their patients with tobacco cessation. We will also assess whether exposure to information and recommendations from the TC-PDA will increase the rate at which patients make at least one serious quit attempt in the month following the dental visit, and increase the use of counseling and pharmacotherapy during those attempts. These data, if promising, would provide the basis for proposing a cluster randomized controlled trial of the TC-PDA as a more robust test of our hypotheses. The ultimate goal of the proposed research is to provide critical new knowledge to accelerate the translation of effective tobacco dependence treatment into the routine care delivered by dental professionals in Community Health Centers and dental practices across the U.S.