Taha Qazi, MD: Addressing Smoking Cessation in the GI Office

A quality-improvement analysis of an electronic health record (EHR)-assisted tobacco treatment model showed utility of digital module training and record-sharing on patient smoking status improved the progression of patients who reported smoking during a gastroenterology visit to cessation treatment by 90%.

Data previously presented by Suha Abushamma, MD, of the Cleveland Clinic, at the Digestive Disease Week (DDW) 2023 Annual Meeting this May showed the 5-step EHR-enabled ELEVATE cessation treatment workflow significantly increased the proportion of patients who, when reporting current smoking status at a gastroenterology clinic, were eventually assisted with cessation resources.

The research, featured in the third issue of Qazi Corner—a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD—may provide a blueprint for specialty practices that which find themselves with many opportunities to intervene on a patient’s smoking status, but without enough time nor resources to adequately help them.

In the third segment of an interview with HCPLive following the latest Qazi Corner, Qazi, a gastroenterologist with the Cleveland Clinic, discussed the myriad gastroenterology risks smokers face: from colorectal and esophageal cancer, to worsened Crohn’s disease and inflammatory bowel disease.

“And in general, we are very busy clinics, and this tends to be things that tend to get covered in the next meeting, then the next meeting—then suddenly it’s 2 years later and the patient is still smoking,” Qazi said. “I think whatever we could do to have multiple touchpoints, to have a conversation with patients regarding the negative effects of smoking, and how we can link certain symptoms with their condition or tobacco dependence, then we can probably move patients from that preconceived stage of smoking to possibly not smoking.”

The ELEVATE concept is to use already available technology to help busy specialists ensure smoking cessation follow-up conversations are taking place at all. Qazi emphasized it may also provide a clear workflow among care team members; administrative assistants or the nursing staff initiate a conversation about smoking history, and physicians present opportunities for cessation in the visit.

A key component, Qazi stressed, is the face-to-face interaction itself.

“I think in many ways, often times the onus is on the patient to report whether they’re smoking, and there tends to be a stigma associated with it,” he said. “I think we need to move away from this reprimanding, paternal aspect of saying, ‘You’ve got to quit,’ and more so have a conversation about, ‘What can I do to help you get through this?’”

Of note, Abushamma and colleagues received an American Gastroenterological Association (AGA) Fellow Abstract Award for their ELEVATE analysis. Qazi praised his colleagues’ success in applying data that deviated from the standard retrospective analyses or otherwise less practice-oriented methods of research.

“Having work that is directly applicable to patient care is oftentimes harder to realize,” Qazi said. “Although there is always arguments for or against quality improvement, I think this is a strategy where it shows that a small change can result in a profound difference in our conversations.”

Read Abushamma’s analysis of ELEVATE from Qazi Corner Issue 3 here.