142nd APHA Annual Meeting and Exposition

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Incorporation of tobacco screening into urologic care in the Veterans Affairs Greater Los Angeles Healthcare System

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Lorna Kwan, MPH , Urology, UCLA, Los Angeles, CA
Jeffrey Bassett, MD , Department of Urology, David Geffen School of Medicine, Los Angeles, CA
John Gore, MD, MS , Department of Urology, University of Washington, Seattle, WA
Christopher Morrison, MD , Department of Urology, Northwestern University, Los Angeles, CA
Sarah Connor, MPH, CHES , Urology, UCLA, Los Angeles, CA
Josemanuel Saucedo , Urology, David Geffen UCLA School of Medicine, Los Angeles, CA
Christopher Saigal, MD, MPH , Department of Urology, UCLA, Los Angeles, CA
William McCarthy, PhD , Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
Introduction

Primary care settings have historically been the foundation of tobacco screening interventions.  Increasingly, evidence-based guidelines urge all clinicians to incorporate screening into usual care.  A number of prominent urologic diseases are tobacco-related including bladder cancer, kidney cancer, and erectile dysfunction.  Despite this, tobacco screening was infrequently occurring in a high volume, regional Veteran Health Administration urology clinic. We hypothesized that this clinic was fertile ground for a tobacco-screening initiative. 

Methods

We designed and implemented an EMR-based tobacco-screening clinical reminder.  Performance measures included proportion of patients asked about tobacco use, advised to quit, and assisted with smoking cessation.

Results

From 2010-2011, 4,608 veterans were referred for initial consultation.  Screening for tobacco use occurred in 57% of consultations.  Of the 1,197 veterans referred for a tobacco-related urologic diagnosis, 787 (66%) were screened for tobacco use.  Utilization of the clinical reminder varied substantially by provider type with attending physicians utilizing the template in 17% of consultations, resident physicians in 71%, and nurse practitioners in 97% (p < .001).  21% (n = 558) of veterans screened were active smokers, of whom 40% were motivated to quit.  Veterans counseled by an attending physician were more likely to indicate a willingness to quit and chose a quit method of greater intensity.

Conclusions

Urology clinics may be fertile ground for tobacco-screening initiatives, particularly for veterans with tobacco-related diagnoses.  Barriers and facilitators to tobacco screening by provider type merits additional study.

Learning Areas:

Administer health education strategies, interventions and programs
Chronic disease management and prevention
Clinical medicine applied in public health
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Describe use of electronic medical records to improve screening for tobacco use. Describe effectiveness of tobacco cessation counseling by health care providers.

Keyword(s): Cancer Prevention and Screening, Tobacco Control

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 20 years experience in health services research and was part of the research team conducting this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4370.1: All Systems Go: Creating a Standard of Care for Cessation