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LeLaurin JH, Theis RP, Thompson LA, Tan ASL, Young-Wolff KC, Carter-Harris L, Shenkman EA, Salloum RG. Tobacco-Related Counseling and Documentation in Adolescent Primary Care Practice: Challenges and Opportunities. Nicotine Tob Res 2020; 22:1023-1029. [PMID: 31074792 DOI: 10.1093/ntr/ntz076] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/09/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Primary care visits present an opportunity to reduce tobacco use and tobacco smoke exposure (TSE) among adolescents. To date, few studies have examined tobacco-related electronic health record (EHR) documentation in adolescent visits. The purpose of this study was to (1) describe tobacco-related EHR documentation practices in adolescent care clinics, including whether alternative tobacco products, parental use, and TSE were addressed; and (2) identify aspects of adolescent tobacco use that may inform EHR updates and counseling and documentation practices. METHODS Following a convergent mixed-methods design, we conducted an EHR review of 508 adolescent well-child visits, performed focus groups with pediatric providers and staff, and conducted in-depth interviews with adolescent patients. Record review data and interview transcripts were analyzed and interpreted concurrently. RESULTS In the EHR review, cigarette screening was documented in 92.3% of visits, smokeless tobacco screening in 51.4%, parental tobacco use in 23.2%, and home TSE in 33.1% of visits. Smoking status options were not mutually exclusive and did not include noncigarette products. No records documented assessment of e-cigarette use, despite nearly half of adolescent interview respondents citing these as the most popular products among adolescents. In interviews, adolescents discussed their experiences with alternative tobacco/nicotine products more than cigarettes. CONCLUSIONS Tobacco use status prompts should be revised for clarity and include noncigarette tobacco products and TSE. Provider education on noncigarette products and TSE assessment is needed. Improvements in EHR systems, resources, and tools can lead to better tobacco screening, prevention, and treatment practices among primary care providers. IMPLICATIONS Clinical guidelines call for pediatricians to assess and treat adolescent and parental tobacco use during primary care visits. The use of electronic health records (EHRs) can improve screening and counseling practices; however, few studies have examined tobacco-related EHR documentation practices in adolescent care settings. This mixed-methods study found low rates of EHR documentation related to noncigarette nicotine/tobacco products, parental tobacco use, and tobacco smoke exposure. These results demonstrate the need for increased provider training and EHR modifications to facilitate comprehensive tobacco control efforts in the adolescent population.
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Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL
| | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL.,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL
| | - Andy S L Tan
- Department of Social and Behavioral Health, Harvard TH Chan School of Public Health, Boston, MA
| | - Kelly C Young-Wolff
- Dana-Farber Cancer Institute, Boston, MA.,Kaiser Permanente Division of Research, Oakland, CA
| | - Lisa Carter-Harris
- Department of Psychology and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL
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