Computerized assessment of surgical patients for tobacco use: accuracy and acceptability

Smoking, Quitting, and the Provision of Smoking Cessation Support: A Survey of Orthopaedic Trauma Patients

OBJECTIVE

This study investigates orthopaedic trauma patients smoking cessation history, intentions to quit, receipt of smoking cessation care during hospital admission, and patient-related factors associated with receipt of smoking cessation care.

METHODS

An online cross-sectional survey of orthopaedic trauma patients was conducted in 2 public hospitals in New South Wales, Australia. Prevalence of smoking and associated variables were described. Logistic regressions were used to examine whether patient characteristics were associated with receipt of smoking cessation care.

RESULTS

Eight hundred nineteen patients (response rate 73%) participated. More than 1 in 5 patients (21.8%) were current smokers (n = 175). Of the current smokers, more than half (55.3%) indicated making a quit attempt in the last 12 months and the majority (77.6%) were interested in quitting. More than a third of smokers (37.4%) were not advised to quit; 44.3% did not receive any form of nicotine replacement therapy; and 24.1% reported that they did not receive any of these 3 forms of smoking cessation care during their admission. Provision of care was not related to patient characteristics.

CONCLUSIONS

The prevalence of smoking among the sample was high. Respondents were interested in quitting; however, the provision of care during admission was low. Smoking cessation interventions need to be developed to increase the provision of care and to promote quit attempts in this Australian population.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Access to chronic disease care in general practice: the acceptability of implementing systematic waiting-room screening using computer-based patient-reported risk status

BACKGROUND

Routine screening and advice regarding risky lifestyle behaviours is appropriate in the primary care setting, but often not implemented. Routine electronic collection of patients' self-reported data may streamline the collection of such information.

AIM

To explore the perceptions of GPs and their attending patients regarding the acceptability of waiting-room touchscreen computers for the collection of health behaviour information. Uptake, ease of operation, and the perceived likelihood of future implementation were studied.

DESIGN AND SETTING

Cross-sectional health-risk survey. General practices in metropolitan areas in Australia.

METHOD

Practices were randomly selected by postcode. Consecutive patients who were eligible to take part in the study were approached in the waiting room and invited to do so. Participants completed the touchscreen health survey. A subsample of patients and GPs completed additional items regarding acceptability.

RESULTS

Twelve general practices participated in the study, with 4058 patients (86%) and 51 of 68 (75%) GPs consenting to complete the health-risk survey, 596 patients and 30 GPs were selected to complete the acceptability survey. A majority of the 30 GPs indicated that the operation of the survey was not disruptive to practice and more than 90% of patients responded positively to all items regarding its operation. More than three-quarters of the patient sample were willing to consider allowing their responses to be kept on file and complete such surveys in the future.

CONCLUSION

As waiting-room-based collection of this information appears to be both feasible and acceptable, practitioners should consider collecting and incorporating routine patient-reported health behaviours for inclusion in the medical record.

Assessing smoking status in disadvantaged populations: is computer administered self report an accurate and acceptable measure?

Background

Self report of smoking status is potentially unreliable in certain situations and in high-risk populations. This study aimed to determine the accuracy and acceptability of computer administered self-report of smoking status among a low socioeconomic (SES) population.

Methods

Clients attending a community service organisation for welfare support were invited to complete a cross-sectional touch screen computer health survey. Following survey completion, participants were invited to provide a breath sample to measure exposure to tobacco smoke in expired air. Sensitivity, specificity, positive predictive value and negative predictive value were calculated.

Results

Three hundred and eighty three participants completed the health survey, and 330 (86%) provided a breath sample. Of participants included in the validation analysis, 59% reported being a daily or occasional smoker. Sensitivity was 94.4% and specificity 92.8%. The positive and negative predictive values were 94.9% and 92.0% respectively. The majority of participants reported that the touch screen survey was both enjoyable (79%) and easy (88%) to complete.

Conclusions

Computer administered self report is both acceptable and accurate as a method of assessing smoking status among low SES smokers in a community setting. Routine collection of health information using touch-screen computer has the potential to identify smokers and increase provision of support and referral in the community setting.

Providing comprehensive smoking cessation care to surgical patients: the case for computers

INTRODUCTION AND AIMS

The provision of smoking cessation care to surgical patients before admission can reduce post-operative complications and encourage long-term smoking cessation. Our aim was to show how a comprehensive computer-based smoking cessation intervention, developed to enhance smoking cessation care to surgical patients, addresses barriers to care provision.

DESIGN AND METHODS

Consultations with preoperative clinic staff and reviews of the scientific literature were conducted and identified the following barriers to the provision of effective smoking cessation care: a lack of organisational support, perceived patient objection, a lack of systems to identify smokers, a lack of staff time and skill, perceived inability to change care practices, a perceived lack of efficacy of cessation care and the cost of providing care. Based on positive findings of a pilot trial, a comprehensive computer-based smoking cessation intervention was implemented in a preoperative clinic. Data from previous evaluations of the intervention were used to assess the extent to which the intervention addressed clinician barriers to care.

RESULTS

The computer-based intervention was found to provide a means to accurately and systematically identify smokers; it required little clinical staff time or skill; it was considered an acceptable form of care by staff and patients; it was effective in encouraging patient cessation and it was inexpensive to deliver relative to other surgical costs. Furthermore, the computer-based intervention continues to operate in the preoperative clinic in the absence of ongoing research support.

DISCUSSION AND CONCLUSIONS

The implementation of such a model of care should be considered by clinical services interested in reducing the smoking related morbidity and mortality of patients.