Enhanced physician prompts in prenatal electronic medical records impact documentation on smoking cessation

Lisa D Levine,Peter S Bernstein,Jitsen Chang,Irwin R Merkatz

doi:10.4236/ojog.2013.310132

Abstract

ObjectiveSmoking cessation during pregnancy is a modifiable intervention that can improve maternal and neonatal outcomes. Encouraging smoking cessation is an assessed measure of the Meaningful Use incentives to ensure best practices with the increased use of the electronic medical record (EMR). Physician EMR prompts have been used shown to be successful with preventive care but there is a paucity of data evaluating prompts within obstetrics. The objective of this study is to determine the effectiveness of enhanced smoking cessation prompts in a prenatal EMR.MethodsA retrospective cohort study of an enhanced smoking cessation prompting system within our prenatal EMR was performed. Pregnant women who reported tobacco use at first prenatal visit were included. The number of times a smoking cessation method was offered and documented, the number of documented attempts at smoking cessation, and the final number of cigarettes smoked were compared pre and post the enhancement of the smoking cessation prompting system.Results95 patients were included (48 pre-enhancement; 47 post-enhancement). Post-enhancement, the documentation of smoking cessation method offered increased (0 vs. 1, p = 0.03) and documentation of smoking cessation attempts increased (1 vs. 2, p = 0.006). There was no change in the final number of cigarettes smoked (p = 0.9).ConclusionsEnhanced prompting systems increase documentation related to smoking cessation with no change in number of cigarettes smoked. In the era of Meaningful Use guidelines which focus on documentation in the EMR, continued research must be done to assure that software enhancements and improved documentation truly result in improved patient care.

Highlights

The increased risk of poor pregnancy outcomes among women who smoke is well known and the importance of smoking cessation during pregnancy is a goal emphasized by numerous professional and public health organizations [1,2,3]
Encouraging smoking cessation is an assessed measure of the Meaningful Use incentives to ensure best practices with the increased use of the electronic medical record (EMR)
We identified a total of 55 patients that had “tobacco use” documented at their first prenatal visit and had an estimated delivery date (EDD) in 2005 and 55 patients with an EDD in 2007

Summary

Introduction

The increased risk of poor pregnancy outcomes among women who smoke is well known and the importance of smoking cessation during pregnancy is a goal emphasized by numerous professional and public health organizations [1,2,3]. Efforts to encourage smoking cessation have become a measure to be reported to the federal government as part of Meaningful Use incentives designed to ensure best practices with the adoption of electronic medical records (EMR) by health care organizations [4]. While directed counseling sessions by trained professionals have been shown to be an effective approach for achieving smoking cessation among pregnant women, the data suggest that physicians must offer effective tobacco cessation interventions throughout prenatal care [5,6]. Rigotti and colleagues demonstrated that 80% of the pregnant women in their study were encouraged to quit smoking by their prenatal care provider, only OPEN ACCESS. Levine et al / Open Journal of Obstetrics and Gynecology 3 (2013) 717-721

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Discussion

Conclusion