HC Chang, LH Zimmerman and JM Beck
Pulmonary and Critical Care Medicine Section (111G), Veterans Affairs Medical Center, Ann Arbor, MI 48105, USA.

Cigarette smoking remains one of the most preventable causes of premature death in our society, yet only a third to a half of smokers visiting a physician are counseled to quit. In the primary care setting, chart reminders can increase physician smoking cessation counseling rates. It is unclear, however, whether pulmonary physicians require prompting to discuss smoking cessation with patients. We hypothesized that chart reminders would improve the smoking cessation counseling and referral practices in our pulmonary clinic. Chart reviews were performed for two 1-mo periods and documentation of smoking status, counseling, and referrals to smoking cessation clinic were recorded. After the implementation of chart reminders, charts were reviewed at 1, 3, and 8 mo. Chart reminders increased documentation of smoking status from 33 to 83% (p = 0.0001). The proportion of all patients counseled increased from 6.0 to 13.2% (p = 0.01). The improvement in counseling to quit occurred primarily by increasing the identification of active smokers. Pulmonary physicians counseled 70% of smokers to quit once patients were identified as smokers. Chart reminders, an inexpensive and easily implemented smoking cessation intervention, increased the overall number and proportion of patients counseled to stop smoking by increasing the number of identified smokers. This simple intervention can improve counseling in populations at high risk for smoking related lung disease.

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