Usage of a web-based clinical decision support system for tobacco cessation counseling

Background: Dental providers have a central role in providing evidence-based tobacco cessation services. Yet provider adherence to Public Health Services Guidelines (PHS Guidelines) on Treating Tobacco Use and Dependence is poor. Clinical decision support systems (CDSS) are promising strategies for increasing provider adherence to guideline recommended care. Methods: We developed a web-based CDSS for assessing smokers' readiness to quit and prescribing appropriate cessation medication in the NYU College of Dentistry general dental clinics. Based on the PHS Guidelines, the CDSS was tailored to dental providers based on a development process of definition, usability and clinical testing. Providers can access it by using any internet capable mobile device. The CDSS collects and stores information on application usage and Google analytics was used to capture end-user data. After a baseline assessment of current tobacco use treatment patterns, providers received a 45-minute training on using the system. Results: From October 17, 2012 to February 7, 2013, 140 patients were assessed for their tobacco dependence through the CDSS. All patients screened were interested in quitting smoking (100%), 61.5% agreed to try using medication (30.86% tried Nicotine gum, 21% tried lozenge, 26% tried patch, and 22.2% tried Varenicline). Providers did not document if patients were referred to the state Quitline. Seventy patients received the tailored printed patient education sheet. According to Google analytics, dentists spent approximately 1.43 minutes using the CDSS. Conclusion: There was good adoption of the tool. Among the 200 dental students and faculty, 59% used the tool at least once. Preliminary qualitative assessments indicate the tool is simple to use, trusted by providers, and facilitates treatment. This CDSS has the potential to enhance quality and consistency of tobacco use treatment in dental health care settings. Further analysis is planned to assess, qualitatively, barriers and facilitators of adoption and usefulness of the system.