Factors associated with physician interventions to address adolescent smoking. Health Serv Res 2004 Jun;39(3):571-86
Date
05/20/2004Pubmed ID
15149479Pubmed Central ID
PMC1361025DOI
10.1111/j.1475-6773.2004.00245.xScopus ID
2-s2.0-2542448156 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
OBJECTIVE: To determine the percent of adolescent Medicaid patients with medical record documentation about tobacco use status and cessation assistance; and factors associated with providers documenting and intervening with adolescent smokers.
DATA SOURCE: Secondary analysis of data collected in 1999 from medical records of Wisconsin Medicaid health maintenance organization (HMO) recipients 11 to 21 years old.
STUDY DESIGN: Random reviews and data collection were related to visits from January 1997 to January 1999. Data collected included patient demographics, provider type, number of visits, and whether smoking status and cessation interventions were documented.
DATA EXTRACTION METHODS: Medical charts were reviewed and a database was created using a data abstraction tool developed and approved by a committee to address tobacco use in Medicaid managed care participants.
PRINCIPAL FINDINGS: Among adolescents seen by a physician from 1997 to 1999, tobacco use status was documented in 55 percent of patient charts. Most often tobacco use status was documented on history and physical or prenatal forms. Of identified adolescent smokers, 50 percent were advised to quit, 42 percent assisted, and 16 percent followed for smoking cessation. Pregnant patients were more likely to have tobacco use documented than nonpregnant patients (OR=10.8, 95 percent CI=4.9 to 24). The odds of documentation increased 21 percent for every one-year increase in patient age.
CONCLUSIONS: Providers miss opportunities to intervene with adolescents who may be using tobacco. Medical record prompts, similar to the tobacco use question on prenatal forms and the tobacco use vital sign stamp, are essential for reminding providers to consistently document and address tobacco use among adolescents.
Author List
Sims TH, Meurer JR, Sims M, Layde PMAuthor
John R. Meurer MD, MBA Institute Director, Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdolescent Health Services
Adult
Child
Counseling
Documentation
Female
Guideline Adherence
Humans
Logistic Models
Male
Medicaid
Medical Audit
Practice Guidelines as Topic
Primary Health Care
Smoking
Smoking Cessation
Smoking Prevention
Wisconsin
