Findings and Future Directions from a Smoking Cessation Trial Utilizing a Clinical Decision Support Tool

Abstract

Background Tobacco smoking is the leading cause of disease, death, and disability in the United States. Dental practitioners are advised to provide evidence-based smoking cessation interventions to their patients, yet dental practitioners frequently fail to deliver brief smoking cessation advice. Objectives To test whether giving dental practitioners a clinical decisions support (CDS) system embedded in their electronic dental record would increase the rate at which patients who smoke 1) report receiving a brief intervention or referral to treatment during a recent dental visit, 2) taking action related to smoking cessation within 7 days of visit, and 3) stop smoking for one day or more or reduce the amount smoked by 50% within 6 months. Methods Two-group, parallel arm, cluster-randomized trial. From March through December 2019, 15 non-academic primary care dental clinics were randomized via covariate adaptive randomization to either a usual care arm or the CDS arm. Adult smokers completed an initial telephone survey within 7 days of their visit and another survey after 6 months. Results Forty-three patients from 5 CDS and 13 patients from 2 usual care clinics completed the 7-day survey. While the proportion of patients who reported receipt of a brief intervention or referral to treatment was significantly greater in the CDS arm than the usual care arm (84.3% versus 58.6%; p = 0.005), the differences in percentage of patients who took any action related to smoking cessation within 7 days (44.4% versus 22.3%; p= 0.077), or stopped smoking for one day or more and/or reduced amount smoked by 50% within 6 months (63.1% versus 46.2%; p = 0.405) were large but not statistically significant. Conclusions Despite interruption by Covid-19, these results demonstrate a promising approach to assist dental practitioners in providing their patients with smoking cessation screening, brief intervention and referral to treatment.