INCLUDING SMOKING STATUS AS A NEW VITAL SIGN - IT WORKS

Background. Despite the adverse health consequences of smoking, many p hysicians still neglect to counsel smokers to quit. This study evaluat ed the effect of including smoking status as a vital sign on the frequ ency of physician discussions with patients about smoking and physicia n advice to quit smoking. Methods. A consecutive sample of adult ambul atory patients in our metropolitan family practice residency program c ompleted exit surveys on physician and nurse counseling about smoking. Control group data were collected for 1 month before the change was m ade to include smoking status as a vital sign on patient charts. Chart s were then marked with a stamp as a chart prompt in the vital signs s ection. Data were collected for 2 months after smoking status was adde d to the stamp. Results. There were 637 individuals surveyed, of whom 179 were current smokers; 95 in the ''prestamp'' group and 84 in the ' 'poststamp'' group. The percentage of patient-physician encounters dur ing which smoking was discussed increased from 47% to 86% (P<.001). Ph ysician advice to quit increased from 50% to 80% (P<.001). Physician d iscussion of smoking with patients increased across all of the five st ages of change but most dramatically (53% to 95%) in the ''preparation '' stage. Physicians were much less likely to counsel patients in the ''precontemplation'' stage to quit smoking. Conclusions. Including smo king as a new vital sign significantly increased the likelihood of smo king-related discussions between patients and their physicians. The st amp is inexpensive and easy to use, and because it is a one-time offic e system change, it is more likely to be implemented and maintained in busy practices.