Testing Clinical Decision Support for Treating Tobacco Use in Dental Clinics

Despite considerable progress, smoking remains the leading preventable cause of death in the United States. Although safe and effective treatments for tobacco dependence exist, only a small proportion of the 40 percent of smokers who try to quit each year use cessation therapies. With more than half of smokers visiting a dentist each year, dentists are in an ideal position to provide cessation treatment, but less than 25 percent routinely do so. Barriers to routine smoking cessation interventions include lack of time, limited training in behavioral assessment and intervention, a lack of office-based systems to facilitate preventive care, and a lack of referral resources.

This project implemented and evaluated a Web-based clinical decision support system (CDSS) to help dentists provide guidance on tobacco cessation during patient encounters. Based on the patient information entered, the system helped dentists recommend and prescribe approved pharmacotherapy; facilitate referral of patients to local counseling resources; print handouts with patient-specific smoking cessation recommendations, instructions, and cessation resources; and document the visit for the patient’s dental record.

The specific aims of this project were as follows:

• Test the hypothesis that a CDSS will improve the rate at which dentists assist their patients with smoking cessation by providing information and recommendations on smoking cessation resources. 
• Assess whether exposure to information and recommendations facilitated by the CDSS would: 1) increase the rate at which patients make at least one quit attempt in the month following the dental visit and 2) increase the reported use of counseling and pharmacotherapy during those attempts over that observed with a tobacco use identification system alone. 
• Evaluate the acceptance of the CDSS into the workflow of dental clinics. 

A cross-sectional pre-post study design was used to assess the impact and acceptability of the CDSS in six general dental clinics. The study demonstrated that implementation of the system was feasible and facilitated treatment of tobacco use. In qualitative interviews, dentists reported that the CDSS was easy to use and helpful for patient care, and that it provided trustworthy information. Patient interviews conducted after a visit found that there were no significant changes in rates of cessation assistance after the system was implemented. However, patient telephone surveys found that patients were significantly more likely to report a quit attempt, read the patient self-help materials, and contact a Quitline.

The study concluded that CDSS has the potential to enhance quality and consistency of tobacco cessation treatment in dental health care settings. The research team recommended that future studies focus on measuring clinical outcomes, identifying facilitators and barriers of integrating the CDSS into provider workflow, and testing the system in a non-academic environment.