Health care provider reminder systems for tobacco cessation
Provider reminder systems remind or encourage health professionals to support tobacco cessation among their patients. Such systems can include provider trainings, organizational protocols or referral processes, financial remuneration for providers, and materials such as self-help pamphlets and pharmacotherapy (e.g., nicotine replacement therapy (NRT)) (Rosseel 2012). A 2013 survey suggests that physicians are more likely to advise quitting than to discuss cessation strategies or medications (NCQA 2013).
Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
- Increased quit rates
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
- Reduced youth smoking
- Increased access to cessation treatment
What does the research say about effectiveness? -+
There is strong evidence that provider reminder systems for tobacco cessation improve quit rates (CG-Tobacco, Abrams 2010). Reminders and training encourage health care providers to conduct brief tobacco interventions (Freund 2009, Pbert 2006), which then help patients quit smoking (Abrams 2010). Dental office (Cochrane-Carr 2012, Gordon 2006, Dent 2007), physician (Cochrane-Stead 2013), and nurse-led (Cochrane-Rice 2013) interventions have all been shown to help smokers quit smoking. In some circumstances, interventions may persuade youth not to start (Patnode 2013, Gordon 2006).
Dental office interventions improve quit rates (Gordon 2006, Dent 2007) for both smokers and smokeless tobacco users (Cochrane-Carr 2012). Including feedback on patients’ salivary nicotine levels and nicotine replacement therapy (NRT) provision may yield especially strong effects. Researchers suggest involving the entire dental team, integrating structured protocols into the care routine, and combining provider education with ongoing support so that providers will support patient cessation (Rosseel 2012).
Physician-led interventions that are brief (Aveyard 2012) and more intensive both improve quit rates. Longer consultations or more follow-ups can yield somewhat stronger effects than minimal advice (Cochrane-Stead 2013). Advice provided with NRT appears more effective than advice alone (Aveyard 2012). Providing NRT without screening may also increase quit rates (Aveyard 2012).
Nurse advice or counseling also improves quit rates (Cochrane-Rice 2013). More intense interventions or interventions conducted by a health promotion or smoking cessation-focused nurse may yield stronger effects than brief interventions or those conducted by nurses with other primary roles (Cochrane-Rice 2013).
The U.S. Department of Health and Human Services recommends providers use the 5 As (Ask, Advise, Assess, Assist, and Arrange) to identify smokers ready to quit, equip them with quitting tools, and arrange follow-up treatment (US DHHS-Treating tobacco use). Electronic health record system prompts (Cochrane-Boyle 2014) or financial incentives for physicians or clinics can increase documentation of tobacco status and referrals to cessation counseling. However, additional evidence is needed to determine the effects of financial incentives on quit rates (Hamilton 2013).
Some studies of practices without reminder systems indicate that white patients are more likely to be screened and counseled than minority patients (Sonnenfeld 2009, Cokkinides 2008, Collins 2017, Palmer 2011) and white adolescent females with private insurance are more likely to receive screening and counseling than their counterparts (Collins 2017). Reminder systems may help to reduce these disparities (Palmer 2011).
Provider reminder systems appear to be more cost-effective than other tobacco reduction interventions (Feenstra 2005).
Implementation Examples -+
CDC Survey data indicates that about 69% of smokers want to quit (NCQA 2013).
Implementation Resources -+
AHRQ-Tobacco pathfinder - Agency for Healthcare Research and Quality (AHRQ). Treating tobacco use and dependence pathfinder: 2008 update.
PFP-Provider reminder systems - Partnership for Prevention (PFP). Healthcare provider reminder systems, provider education, and patient education: Working with healthcare delivery systems to improve the delivery of tobacco-use treatment to patients - An action guide. Washington, D.C.: Partnership for Prevention; 2008.
Rx for change - University of California San Francisco. Rx for change: Clinician-assisted tobacco cessation.
Smokefree.gov-Health care professionals - U.S. Department of Health and Human Services (U.S. DHHS). Smokefree.gov. Resources for health care professionals.
Citations -+
* Journal subscription may be required for access.
Abrams 2010* - Abrams DB, Graham AL, Levy DT, Mabry PL, Orleans CT. Boosting population quits through evidence-based cessation treatment and policy. American Journal of Preventive Medicine. 2010;38(3 Suppl):S351-63.
Aveyard 2012* - Aveyard P, Begh R, Parsons A, West R. Brief opportunistic smoking cessation interventions: A systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. 2012;107(6):1066–73.
CG-Tobacco - The Guide to Community Preventive Services (The Community Guide). Tobacco.
Cochrane-Boyle 2014* - Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database of Systematic Reviews. 2014;(12):CD008743.
Cochrane-Carr 2012* - Carr AB, Ebbert J. Interventions for tobacco cessation in the dental setting. Cochrane Database of Systematic Reviews. 2012;(6):CD005084.
Cochrane-Rice 2013* - Rice VH, Hartmann-Boyce J, Stead LF. Nursing interventions for smoking cessation. Cochrane Database Systematic Reviews. 2013;(8):CD001188.
Cochrane-Stead 2013* - Stead LF, Buitrago D, Preciado N, et al. Physician advice for smoking cessation. Cochrane Database Systematic Reviews. 2013;(5):CD000165.
Cokkinides 2008* - Cokkinides VE, Halpern MT, Barbeau EM, Ward E, Thun MJ. Racial and ethnic disparities in smoking-cessation interventions: Analysis of the 2005 national health interview survey. American Journal of Preventive Medicine. 2008;34(5):404-12.
Collins 2017 - Collins L, Smiley SL, Moore R, et al. Physician tobacco screening and advice to quit among U.S. adolescents: National Survey on Drug Use and Health, 2013. Tobacco Induced Diseases. 2017;15(2).
Dent 2007* - Dent LA, Harris KJ, Noonan CW. Tobacco interventions delivered by pharmacists: A summary and systematic review. Pharmacotherapy. 2007;27(7):1040–51.
Feenstra 2005 - Feenstra TL, Hamberg-van Reenen HH, Hoogenveen RT, Rutten-van Mölken MPMH. Cost-effectiveness of face-to face smoking cessation interventions: A dynamic modeling study. Value In Health. 2005;8(3):178-90.
Freund 2009* - Freund M, Campbell E, Paul C, et al. Increasing smoking cessation care provision in hospitals: A meta-analysis of intervention effect. Nicotine & Tobacco Research. 2009;11(6):650-62.
Gordon 2006* - Gordon JS, Lichtenstein E, Severson HH, Andrews JA. Tobacco cessation in dental settings: Research findings and future directions. Drug and Alcohol Review. 2006;25(1):27-37.
Hamilton 2013* - Hamilton F, Greaves F, Majeed A, Millett C. Effectiveness of providing financial incentives to healthcare professionals for smoking cessation activities: Systematic review. Tobacco Control. 2013;22(1):3–8.
NCQA 2013 - National Committee for Quality Assurance (NCQA). Improving quality and patient experience: The state of health care quality 2013. Washington, D.C.: National Committee for Quality Assurance (NCQA); 2013.
Palmer 2011 - Palmer RC, McKinney S. Health care provider tobacco cessation counseling among current African American tobacco users. Journal of the National Medical Association. 2011;103(8):660-667.
Patnode 2013 - Patnode CD, O’Connor E, Whitlock EP, et al. Primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents: A systematic evidence review for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2013;158(4):253–60.
Pbert 2006 - Pbert L, Fletcher KE, Flint AJ, et al. Smoking prevention and cessation intervention delivery by pediatric providers, as assessed with patient exit interviews. Pediatrics. 2006;118(3):e810-24.
Rosseel 2012* - Rosseel J, Jacobs J, Plasschaert A, Grol R. A review of strategies to stimulate dental professionals to integrate smoking cessation interventions into primary care. Community Dental Health. 2012;29(2):154–61.
Sonnenfeld 2009* - Sonnenfeld N, Schappert SM, Lin SX. Racial and ethnic differences in delivery of tobacco-cessation services. American Journal of Preventive Medicine. 2009;36(1):21-8.
US DHHS-Treating tobacco use - Tobacco Use and Dependence Guideline Panel. Treating tobacco use and dependence: 2008 Update. Rockville: U.S. Department of Health and Human Services (U.S. DHHS); 2008.