Smoking Cessation Care in a Tertiary Center's Gastroenterology (GI) Clinics - Success Using an Electronic Health Record (EHR) Point of Care Cessation Support Module

Introduction: Smoking is a major risk factor for multiple GI cancers and adversely affects gallstones, pancreatitis, peptic ulcer and Crohn’s disease. However, diagnosing and treating tobacco use disorder is infrequently practiced in GI clinics. We aim to evaluate whether use of an EHR-assisted point of care model increases reach of tobacco treatment in our GI clinics. Methods: Using a pre/post intervention study, we evaluated the effectiveness of a quality improvement initiative implemented at a tertiary medical center's GI clinics. The tobacco cessation intervention framework consists of the “5 A’s” and leverages Epic EHR functionality to ensure consistent tobacco use assessment and cessation treatment support for our patients. This workflow begins when the medical assistant (MA) Asks about tobacco use and Advises cessation, including a brief script: “One of the best things you can do for your health is to quit smoking.” For all patients who smoke, a Tobacco Intervention Best Practice Advisory (BPA) prompts the MA to Assess patient motivation and Assist with referrals to additional tobacco treatment via phone-based, text-based, and smartphone app-based counseling. Another BPA prompts physicians to prescribe medications. Finally, nicotine dependence is added as part of the BPA in the problem list for ongoing tracking and follow up. Results: We evaluated EHR data during 3 months pre- and post-intervention, which was launched in 1/2021. During pre-intervention, out of the 4533 patients who visited our GI clinics, 87.3% were assessed for smoking. This is in comparison to 88.7% of patients who visited our clinics post-intervention (P = 0.04). Moreover, only 3% of smokers were on any treatment pre-intervention, whereas 20% of smokers were on treatment afterwards (P < 0.0001). Treatment was in the form of brief advice given (0.8% pre-intervention vs 12.9% post-intervention, P < 0.0001), additional counseling offered (0.6% pre-intervention vs 33.8% post-intervention, P < 0.0001), additional counseling referred (0.6% pre-intervention vs 9.1% post-intervention, P < 0.0001), or medications (non-significant difference). Conclusion: The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a sixfold increase in the treatment of smoking in our GI clinics with minimal resources and disruption to clinic workflow. This study sheds light on an often under-recognized source of morbidity in our GI patients and identifies an efficient and effective strategy to combat tobacco use in our clinics.Table 1.: Smoking Prevalence and Treatment Among GI Patients Pre-Module vs Post-Module.