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Who are we missing with EHR-based smoking cessation treatments? A descriptive study of patients who smoke and do not regularly visit primary care clinics

Published online by Cambridge University Press:  03 September 2020

Margaret Nolan Open the ORCID record for Margaret Nolan [Opens in a new window] ,
Deejay Zwaga ,
Danielle McCarthy ,
Christian Kastman ,
Timothy Baker ,
Mark Zehner ,
Stevens Smith  and
Michael Fiore
Margaret Nolan*
Affiliation:
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
Deejay Zwaga
Affiliation:
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
Danielle McCarthy
Affiliation:
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
Christian Kastman
Affiliation:
Group Health Cooperative of South Central Wisconsin, Madison, WI 53726, USA
Timothy Baker
Affiliation:
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
Mark Zehner
Affiliation:
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
Stevens Smith
Affiliation:
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
Michael Fiore
Affiliation:
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
*
Author for correspondence: Margaret Nolan, E-mail: [email protected]
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Abstract

Introduction

Most tobacco treatment efforts target healthcare settings, because about 75% of smokers in the United States visit a primary care provider annually. Yet, 25% of patients may be missed by such targeting.

Aims

To describe patients who smoke but infrequently visit primary care – their characteristics, rates of successful telephone contact, and acceptance of tobacco treatment.

Methods

Tobacco Cessation Outreach Specialists ‘cold-called’ those without a primary care visit in the past year, offering tobacco dependence treatment. Age, sex, insurance status, race, ethnicity, electronic health record (EHR) patient-portal status and outreach outcomes were reported.

Results

Of 3,407 patients identified as smokers in a health system registry, 565 (16.6%) had not seen any primary care provider in the past year. Among 271 of those called, 143 (53%) were successfully reached and 33 (23%) set a quit date. Those without visits tended to be younger, male, some-day versus every-day smokers (42 vs. 44 years, P = 0.004; 48% vs. 40% female, P = 0.0002, and 21% vs. 27% some-day, P = 0.003), and less active on the EHR patient portal (33% vs. 40%, P = 0.001).

Conclusions

A substantial proportion of patients who smoke are missed by traditional tobacco treatment interventions that require a primary care visit, yet many are receptive to quit smoking treatment offers.

Keywords

Electronic medical recordpopulation approachprimary care
Type
Original Articles
Information
Journal of Smoking Cessation , Volume 15 , Issue 4 , December 2020 , pp. 175 - 180
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Adsit, R. T., Fox, B. M., Tsiolis, T., Ogland, C., Simerson, M., Vind, L. M., … Fiore, M. C. (2014). Using the electronic health record to connect primary care patients to evidence-based telephonic tobacco quitline services: A closed-loop demonstration project. Translational Behavioral Medicine, 4(3), 324–332. doi: 10.1007/s13142-014-0259-yCrossRefGoogle ScholarPubMed
Bernstein, S. L., Dziura, J., Weiss, J., Miller, T., Vickerman, K. A., Grau, L. E., … Toll, B. (2018). Tobacco dependence treatment in the emergency department: A randomized trial using the Multiphase Optimization Strategy. Contemporary Clinical Trials, 66, 1–8. doi: 10.1016/j.cct.2017.12.016CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. (2019). Diseases and death. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htmGoogle Scholar
Creamer, M. R., Wang, T. W., Babb, S., Cullen, K. A., Day, H., Willis, G., … Neff, L. (2019). Tobacco product use and cessation indicators among adults – United States, 2018. MMWR. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. doi: 10.15585/mmwr.mm6845a2CrossRefGoogle ScholarPubMed
Epic. (2017). In a nutshell. Retrieved from https://www.epic.com/about.Google Scholar
Fiore, M., Adsit, R., Zehner, M., McCarthy, D., Lundsten, S., Hartlaub, P., … Baker, T. (2019). An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care. Journal of the American Medical Informatics Association, 26(8–9), 778–786. doi: 10.1093/jamia/ocz044CrossRefGoogle ScholarPubMed
Fiore, M. C., Jaen, C. R., Baker, T. B., Bailey, W. C., Benowitz, N., Curry, S. J., … Wewers, M. E. (2008). Treating tobacco use and dependence: 2008 update. Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service.Google Scholar
Hiscock, R., Bauld, L., Amos, A., Fidler, J. A., & Munafo, M. (2012). Socioeconomic status and smoking: A review. Annals of the New York Academy of Sciences, 1248, 107–123. doi: 10.1111/j.1749-6632.2011.06202.xCrossRefGoogle ScholarPubMed
Jorm, L. R., Shepherd, L. C., Rogers, K. D., & Blyth, F. M. (2012). Smoking and use of primary care services: Findings from a population-based cohort study linked with administrative claims data. BMC Health Services Research, 12, 263. doi: 10.1186/1472-6963-12-263CrossRefGoogle ScholarPubMed
King, B. A., Dube, S. R., Babb, S. D., & McAfee, T. A. (2013). Patient-reported recall of smoking cessation interventions from a health professional. Preventive Medicine, 57(5), 715–717. doi: 10.1016/j.ypmed.2013.07.010CrossRefGoogle ScholarPubMed
Kubota, Y., Higashiyama, A., Marumo, M., Konishi, M., Yamashita, Y., Tashiro, C., … Wakabayashi, I. (2017). Detection of subclinical peripheral artery ischemia in healthy male smokers by an ankle-brachial index after exercise: Sasayama Study. Angiology, 68(9), 769–775. doi: 10.1177/0003319717694366CrossRefGoogle ScholarPubMed
Pleasants, R. A., Riley, I. L., & Mannino, D. M. (2016). Defining and targeting health disparities in chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 11, 2475–2496. doi: 10.2147/COPD.S79077CrossRefGoogle ScholarPubMed
Santini, G., Mores, N., Shohreh, R., Valente, S., Dabrowska, M., Trove, A., … Montuschi, P. (2016). Exhaled and non-exhaled non-invasive markers for assessment of respiratory inflammation in patients with stable COPD and healthy smokers. Journal of Breath Research, 10(1), 017102. doi: 10.1088/1752-7155/10/1/017102CrossRefGoogle ScholarPubMed
Schlichthorst, M., Sanci, L. A., Pirkis, J., Spittal, M. J., & Hocking, J. S. (2016). Why do men go to the doctor? BMC Public Health, 16(Suppl 3), 1028.10.1186/s12889-016-3706-5CrossRefGoogle ScholarPubMed
Smith, C. F., Whitaker, K. L., Winstanley, K., & Wardle, J. (2016). Smokers are less likely than non-smokers to seek help for a lung cancer ‘alarm’ symptom. Thorax, 71(7), 659–651.10.1136/thoraxjnl-2015-208063CrossRefGoogle Scholar
Stead, L. F., Buitrago, D., Preciado, N., Sanchez, G., Hartmann-Boyce, J., & Lancaster, T. (2013). Physician advice for smoking cessation. The Cochrane Database of Systematic Reviews (Issue 5), Art. No. CD000165. doi: 10.1002/14651858.CD000165.pub4Google ScholarPubMed
Toljamo, T., Hamari, A., Nieminen, P., & Kinnula, V. L. (2012). Young male daily smokers are nicotine dependent and experience several unsuccessful quit attempts. Scandinavian Journal of Primary Health Care, 30, 183–188.10.3109/02813432.2012.704809CrossRefGoogle ScholarPubMed
Whittaker, R., McRobbie, H., Bullen, C., Borland, R., Rodgers, A., & Gu, Y. (2012). Mobile phone-based interventions for smoking cessation. The Cochrane Database of Systematic Reviews, 11, CD006611. doi: 10.1002/14651858.CD006611.pub3Google ScholarPubMed
Zhou, Z., Chen, P., & Peng, H. (2016). Are healthy smokers really healthy? Tobacco Induced Diseases, 12, 35. doi: 10.1186/s12971-016-0101-zCrossRefGoogle Scholar