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Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study

¹ Departments of Family Medicine and Epidemiology and Community Health, Virginia Commonwealth University, Richmond
² Departments of Biostatistics and Family Medicine, Virginia Commonwealth University, Richmond
³ Department of Family Medicine, Virginia Commonwealth University, Richmond
⁴ Office of Clinical Research, University of Minnesota, Minneapolis

CORRESPONDING AUTHOR: Stephen F. Rothemich, MD, MS Department of Family Medicine Virginia Commonwealth University 1200 E Broad St PO Box 980251 Richmond, VA 23298-0251 srothemich{at}vcu.edu

PURPOSE Guidelines encourage primary care clinicians to document smoking status when obtaining patients’ blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention influences patient-reported frequency and intensity of tobacco cessation counseling.

METHODS This study was a cluster-randomized, controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network (ACORN). At intervention practices, nurses and medical assistants were instructed to assess the tobacco use status of every adult patient and record it with the traditional vital signs. Control practices did not use any systematic tobacco screening or identification system. Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of 2 counseling subcomponents: simple quit advice and more intensive discussion.

RESULTS A total of 6,729 adult patients (1,149 smokers) at 18 primary care practices completed exit questionnaires during a 6-month comparison period. Among 561 smokers at intervention practices, 61.9% reported receiving any counseling, compared with 53.4% of the 588 smokers at control practices, for a difference of 8.6% (P = .04). The effect was largely restricted to simple advice, which was reported by 59.9% of intervention patients and 51.5% of control patients (P=.04). There was no significant increase in more extensive discussion, with 32.5% and 29.3% of patients at intervention and control practices, respectively, reporting this type of counseling (P=.18).

CONCLUSIONS The vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. When implemented as a stand-alone intervention, it does not appear to increase intensive counseling.

Key Words: Smoking • tobacco • smoking cessation • vital signs • vital sign intervention • health behavior • counseling • primary care • office visits • practice-based research

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