Respiratory morbidity is high in persons with spinal cord injuries and disorders (SCI/D), and smoking significantly contributes to respiratory illnesses. Studies of veterans with SCI/D have found that approximately 30% are current smokers (EPRP FY03-06) despite the high incidence of respiratory impairments in this population.
The purpose of this study was to test the feasibility of using a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians (Unrod, et al. 2007). The expert system poses a series of questions from several validated scales including smokers' motivation for smoking, readiness to quit smoking, and health issues related to smoking. The program summarizes and synthesizes the information to create a one-page feedback report for patients and their providers. The report indicates patients' readiness to quit smoking, and provides tailored recommendations for both the patient and provider based on the patient's smoking characteristics. The goal of that study was to increase providers' performance of the 5 A's (ask, advise, assess, assist and arrange) for smoking cessation.
Patients with SCI/D who were current smokers were recruited from the outpatient clinic or inpatient SCI unit. Following informed consent, patients completed the computer expert system and were given two copies of the one page feedback report. Patients took the feedback report to their clinic appointment or presented to their provider during their inpatient stay. Prior to discharge or after their clinic visit, patients completed an exit interview that asked about the care they received related to smoking and their opinions about using the computer expert system. One month later, the research assistant contacted patents to complete a follow-up interview and completed a review of the patient medical record to record documentation of the the 5As of smoking cessation care (ask, advise, assess, assist and arrange).
Four patients with spinal cord injuries/disorders were enrolled in the pilot at one VA hospital. All were men, between the ages of 58 and 62, and had smoked for more than 40 years. All completed the computer system and provided feedback reports to their providers. all 4 patients reported being asked about smoking, advised to quit, assessed for their readiness to quit and all were followed up (arranged) by the provider at a later time regarding their smoking status. In most cases the providers assisted by writing a prescription (50%) and/or referring to the cessation clinic (75%). Documentation of each of these activities in the patient's medical record was lower, suggesting care provision is higher that documentation would suggest. Patients reported that the computer system was easy and enjoyable to use.
Recruitment of patients was very difficult because of both scheduling difficulties and the burdensome process of informed consent. Follow-up was also difficult, as we were unable to locate half of the patients in a timely manner. Veterans with SCI/D were able to use the computer system and the findings suggest that the feedback report may be helpful in facilitating the provision of guideline recommended care for smoking cessation.
- Weaver FM, Smith B, LaVela SL, Evans CT, Ullrich P, Miskevics S, Goldstein B, Strayer J, Burns SP. Smoking behavior and delivery of evidence-based care for veterans with spinal cord injuries and disorders. The journal of spinal cord medicine. 2011 Jan 1; 34(1):35-45.