Testing clinical decision support for treating tobacco use in dental clinics

摘要 烟草使用是可预防的死亡和疾病的最常见原因。虽然大多数人 在不久的将来，通过帮助现有的吸烟者 戒烟，习惯性吸烟者发现要成功戒烟极其困难。以证据为基础的美国 公共卫生服务治疗烟草使用和依赖指南(PHS指南) 建议所有临床医生确定患者的烟草使用状况，建议吸烟者或 使用其他形式的烟草戒烟，帮助他们戒烟，并对这些尝试进行跟踪。 牙科公共卫生诊所提供了一个独特且相对未被开发的机会来帮助这些患者 最需要戒烟服务的人。认识到牙科在烟草行业中的重要性 控制努力，最新发布的《健康人2020》包括，作为一个关键目标，改善 牙科保健环境中的筛查和戒烟咨询率。大多数吸烟者每年都去看牙医。 吸烟是口腔疾病的已知风险因素。此外，对照试验已经证明 以牙科办公室为基础的短暂戒烟干预的效果。不幸的是，牙医建议 仅向他们的一小部分患者提供戒烟资源。我们解决这个问题的方法一直是 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，并协助他们咨询使用烟草的患者。这个系统是 在个人数字助理(TC-PDA)上开发，用于检查室并指导牙医 制定针对患者的建议，包括有关可用咨询资源的信息 和药物治疗。我们最近完成了实施和使用的可行性测试 这是一家普通牙科诊所的TC-PDA。我们现在准备对它对牙医的影响进行试点测试 遵守PHS指南，并使用横断面前测后测对患者的戒烟行为进行研究 设计用来检验TC-PDA将提高牙医和牙科医生 学生帮助他们的病人戒烟。我们还将评估是否接触到 来自TC-PDA的信息和建议将提高患者在 在看牙医后的一个月内至少有一次严重的戒烟尝试，并增加对 在这些尝试期间进行咨询和药物治疗。这些数据，如果前景看好，将提供 建议TC-PDA的整群随机对照试验作为OUR的更稳健测试的基础 假设。拟议研究的最终目标是为 加快将有效的烟草依赖治疗转化为通过以下方式提供的常规护理 社区卫生中心的牙科专业人员和美国各地的牙科诊所。

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.