Veterans smoke disproportionately higher (nearly 1.3 times greater) than the general population and puts them at greater risk for tobacco-related illnesses. Annual screenings by the primary care providers are conducted at Veterans Health Administration (VHA) primary care clinics, but this practice may be inadequate to overcome the chronicity of smoking. The Ask, Advise, Refer strategy for smoking cessation was integrated in the workflow and implemented by the nursing staff at a VHA outpatient surgery clinic. Nurses established smoking status, advised smokers to quit, and for those interested, provided the smoker a list of resources Department of Veterans Affairs' approved smoking cessation options (telephone, text, and web-based interventions). All the smokers took a referral card containing a list of resources to help them quit smoking. During the follow-up phone calls after the clinic visit, 19% of patients reported using at least one of the resources listed on the card. Each clinical encounter should be viewed by health care providers as a window of opportunity to promote smoking cessation. The simplicity of the AAR strategy is effective in promoting smoking cessation especially in busy outpatient settings.
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