Background: United States Preventive Services Task Force recommends clinicians provide smoking cessation counseling and interventions to all smokers and lung cancer screening with low dose CT scan for high-risk individuals. We aimed to determine the prevalence of smoking cessation counseling and lung cancer screening rate at the residents’ clinic and implement a multimodal plan to improve counseling and screening rate.
Methods: We performed a retrospective review of the electronic medical records (EMR) between August 2020 and November 2020. We gathered data on smoking history documentation, smoking cessation counselling and low dose CT order for lung cancer screening. We included patients above age 18 years with history of smoking but excluded patients seen for transition of care visits and sick visits. We conducted a survey among residents to identify barriers to smoking cessation and lung cancer screening. Lack of information on smoking history documentation in the EMR and unawareness of lung cancer screening guidelines were addressed by conducting educational sessions weekly for six weeks. We utilized locally available resources on Georgia quit line and lung cancer awareness handouts from public health department and made it available at the clinic. We requested pharmacists to conduct smoking cessation clinic and encouraged residents to refer patients to the clinic. A best practice advisory was added to the EMR to remind physicians about lung cancer screening. About 30% of patients vising to our clinic were uninsured; we applied for a grant to cover expenses for low dose CT. After six weeks we evaluated residents’ performance and provided each resident their scores. We awarded top three residents.
Results: Three months prior to interventions 805 patients reported smoking history, but only 526 patients (65.3 %) had complete smoking history documented. 417 patients were eligible for counseling, however only 229 (54.9%) were counseled. 105 patients were eligible for lung cancer screening, however only 32 (30.4%) low dose CT scans were ordered. At the end of three months of the project 1004 patients reported smoking history, 710 patients (70.7 %) had complete smoking history documented. 573 patients were eligible for counseling, 284 (49.5%) were counseled. 145 patients were eligible for lung cancer screening, however 43 (29.6%) low dose CT were ordered. We used STATA/IC proportion test calculator which showed a statistically significant increase in complete smoking history documentation after intervention and a statistically nonsignificant drop in counseling and CT scan orders.
Conclusions: With the interventions there was a significant improvement in complete smoking history documentation which helps to identify high risk patients. There was lack of significant difference in the proportion of counseling and low dose CT order rate. We think the application of the new lung cancer screening guideline (50 years instead of 55 yr and 20 pack year smoking instead of 30 pack year smoking) led to increase in the denominator. Other explanation might be the short duration of intervention and small sample size.We were able to get a grant for low dose CT for lung cancer screening for uninsured patients. Pharmacists in the clinic happily conducted smoking cessation clinic and they decided to continue it for long term. Addition of best practice advisory in the EMR keeps reminding physician about lung cancer screening for eligible patients.