A115 SYSTEMATIZATION AND MODERNIZATION OF AN ANTI-SMOKING PROGRAM IN CROHN’S DISEASE

• Published in: Journal of the Canadian Association of Gastroenterology 2019-03, Vol.2 (Supplement_2), p.229-231
• Main Authors: Cox, B D, Loomes, D E
• Format: Article
• Language: English
• Subjects: Posters Of Distinction
• ISSN: 2515-2084; 2515-2092
• DOI: 10.1093/jcag/gwz006.114

Abstract Background There is a well-established relationship between smoking and disease activity in Crohn’s. The impact of smoking on Crohn’s disease includes increased risk of relapse, disease complications, need for surgery, hospitalization, and flare severity. Despite clear evidence that smoking has a negative impact on Crohn’s disease, research has shown that patients with Crohn’s disease are often unaware of this fact. Furthermore, studies have demonstrated that gastroenterologists do not frequently discuss the importance of smoking cessation or offer cessation strategies to patients. Studies exploring the effect of smoking cessation in Crohn’s patients have found that cessation results in reduced rates of disease flares and the need for steroids and immunosuppression therapy when compared to active smokers. This highlights the importance of smoking cessation in Crohn’s disease, and that it should be an integral part of the management plan for Crohn’s patients. Aims The aim of this study was to evaluate if a comprehensive standardized process for identifying and targeting patients with Crohn’s disease would change management, starting with improved documentation of smoking status in Crohn’s patients, and further progressing to targeted patient education. Methods A standardized anti-smoking program was implemented into the offices of two gastroenterologists. This process change began at patient intake utilizing a patient questionnaire, non-MD EMR input of smoking status, targeted patient intervention using “Smoking and Crohn’s Disease” information pamphlets, and EMR smart-phrases to rapidly document smoking intervention. After 20 months, a chart review was performed on 50 patients from these two offices as well as 200 charts from the offices of an additional ten local gastroenterologists. The rates of smoking status documentation as well as discussion about smoking cessation were compared. Results Of the charts reviewed from the offices that implemented the standardized anti-smoking program intervention, 96% had a documented smoking status, compared to 57% of the charts in the non-intervention group (p = < 0.001). In the intervention group, smoking cessation strategies were discussed with 75% of smokers while there was no documented smoking cessation discussion in the non-intervention group (p = 0.077). Conclusions Having a standardized and comprehensive anti-smoking program and process leads to an increase in documentation rates and discussion about