Implementation of an electronic dental record tool to increase referrals to a tobacco counseling quit line

The problem under investigation: Telephone counseling has been documented to increase smoking cessation rates yet dissemination of the technology into medical practice has been limited. An untapped source of potential telephone counseling referrals is dental hygienists. Implementing a system that cues dentists and dental hygienists to give cessation advice and refer patients to telephone counseling has the potential to increase the number of smokers accessing telephone counseling. We have previously reported on a clinical trial examining a computer-assisted tobacco intervention (CATI) tool embedded in the electronic dental record (EDR). The results showed significant increases in the rate at which dental hygienists assessed interest in quitting, discussed specific strategies for quitting, and referred for telephone counseling. After the conclusion of the trial the system was permanently implemented in both the control and intervention clinics. The question of sustained use is examined in this report.