S1265 Smoking Cessation Care in a Tertiary Center’s Gastroenterology (GI) Clinics: Role of the Electronic Health Record (EHR), Providers’ Practices and Barriers to Success

Abstract

INTRODUCTION: Smoking has an unfavorable effect in various gastrointestinal ailments including peptic ulcer disease and Crohn's disease, and is a risk factor for multiple gastrointestinal cancers. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in GI clinics is unknown. We aim to study the smoking cessation care in our GI clinics across different timeframes with different EHRs, assess our providers' practices and identify perceived barriers for implementing smoking cessation treatments. METHODS: Retrospective cohort study of patients presenting to our institution's outpatient GI clinics. Data was extracted from the period 1–5/2018 while Allscripts was in place, and compared to the period 6–12/2018 after transitioning to EPIC. In addition, our GI attending physicians were invited to complete a survey regarding their smoking cessation care practices. RESULTS: Data for a total of 15,431 patients was extracted. 83% of patients were assessed for smoking pre-EPIC, in comparison to 98% of the patients who had visited our clinics post-EPIC (P < 0.0001). Although more smokers were identified in the cohort of patients pre-EPIC (15.7% vs 14.3%, P = 0.02), more patients were on treatment for smoking cessation post-EPIC (6.5% vs 2.7%, P < 0.0001). 77% attending GI physicians responded to the anonymous survey, and nearly half of them stated they always asked their patients if they smoked. However, 29% of the physicians stated they sometimes or often would assess their patients' willingness to quit at the time of the visit, and 58.8% had never assisted patients by prescribing smoking cessation medications. 82% of the providers reported “Patients not interested” as an extremely/very important barrier, followed by the “Lack of a systematic program to outreach,” reported by 76% of providers as an extremely/very important barrier. CONCLUSION: A significantly higher number of patients were assessed for smoking after the transition to EPIC EHR, largely attributable to EPIC's Best Practice Alert (BPA). Although patients' perceived lack of interest in smoking cessation was regarded as a major barrier to smoking cessation treatment among providers, about one third of providers have never or rarely assessed their patients' willingness to quit smoking. This study sheds light on an often under-recognized source of morbidity in our GI patients, and identifies potential avenues to improve smoking cessation care, including utilization of the EHR.Table 1.: Smoking prevalence and treatment among GI patients pre EPIC vs post EPICFigure 1.: Survey Question: In the past month, how frequently did you assess if patients are willing to attempt to quit at this time?Figure 2.: Survey Question: Please rate the importance of the following that might limit your smoking cessation treatment practice: Lack of a systematic program to outreach and offer help to patients who smoke.