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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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