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.

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

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.

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).

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.