Clinical annotations of tobacco use in patient charts at Indian Health Service clinics and hospitals.

Few clinicians would doubt the importance of obtaining smoking histories from their patients. Nevertheless a clinician's practices of documenting tobacco use in medical records varies substantially among individual providers and between different health care systems. This study investigates chart documentation of patient smoking among Indian Health Service (IHS) clinicians. The investigators reviewed 545 randomly selected patient records from 22 different IHS affiliated clinics. They focused on differences in charting of tobacco use by type of clinic and by geographic area within the IHS. Documentation varied by area, ranging from no documentation in the Albuquerque, Navajo, and Phoenix areas to 51% in the Oklahoma area. The author observes the wide variation in documentation of tobacco use and recommends that this practice be more widely encouraged at all affiliated IHS clinics.