Testing clinical decision support for treating tobacco use in dental clinics

描述（由申请人提供）：烟草使用是可预防死亡和疾病的最常见原因。虽然在不久的将来，通过帮助现有使用者戒烟可以实现烟草死亡率的大部分降低，但习惯性吸烟者发现成功戒烟极其困难。基于证据的美国公共卫生服务烟草使用和依赖治疗指南（PHS指南）建议所有临床医生确定其患者的烟草使用状况，建议吸烟或使用其他形式烟草的人戒烟，协助他们戒烟尝试，并对这些尝试进行随访。牙科公共卫生诊所提供了一个独特的和相对未开发的机会，以帮助那些最需要戒烟服务的病人。认识到牙科在控烟工作中的重要性，新发布的《健康人2020》将提高牙科保健机构的筛查和戒烟咨询率作为一项关键目标。大多数吸烟者每年看一次牙医，吸烟是口腔疾病的一个已知风险因素。此外，对照试验已经证明了以牙科诊所为基础的短暂戒烟干预的有效性。不幸的是，牙医只向他们的一小部分病人推荐戒烟资源。我们解决这个问题的方法是与牙医和牙科学生一起开发一个决策支持系统，提醒牙医执行指南，并协助他们为吸烟患者提供咨询。该系统是在个人数字助理（TC-PDA）上开发的，用于检查室，指导牙医制定针对患者的建议，包括可用咨询资源和药物治疗的信息。我们最近完成了在一家普通牙科诊所实施和使用这种TC-PDA的可行性测试。我们现在准备对其对牙医遵守PHS指南的影响进行试点测试，并使用横断面前测后测设计对患者戒烟行为进行测试，以检验TC-PDA将提高牙医和牙科学生帮助患者戒烟的比率的假设。我们还将评估接触TC-PDA的信息和建议是否会增加患者在牙科就诊后一个月内至少进行一次严重戒烟尝试的比率，并在这些尝试中增加咨询和药物治疗的使用。这些数据，如果有希望，将为提出TC-PDA的集群随机对照试验提供基础，作为对我们假设的更有力的检验。拟议研究的最终目标是提供关键的新知识，以加速将有效的烟草依赖治疗转化为美国社区卫生中心和牙科诊所牙科专业人员提供的常规护理

DESCRIPTION (provided by applicant): 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 its 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. PUBLIC HEALTH RELEVANCE: Despite the existence of effective treatments to support smoking cessation, cigarette smoking remains the leading cause of preventable death in the United States. Dental public health clinics afford a unique and relatively untapped opportunity to help those patients most in need of tobacco cessation services. This translational research project evaluates whether a decision support system on a personal digital assistant enhances dentist tobacco use brief interventions, a preventive service that is known to reduce smoking.