ABSTRACT
Effective treatments for smoking cessation exist but are underused. Proactive chronic care approaches may enhance the reach of cessation treatment and reduce the prevalence of smoking in healthcare systems. This pragmatic study evaluated a population-based Comprehensive Tobacco Intervention Program (CTIP) implemented in all (6) adult primary care clinics in a Madison, Wisconsin, USA healthcare cooperative, assessing treatment reach, reach equity, and effectiveness in promoting smoking cessation. CTIP launched in 3 waves of 2 clinics each in a multiple baseline design. Electronic health record (EHR) tools facilitated clinician-delivered pharmacotherapy and counseling; guiding tobacco care managers in phone outreach to all patients who smoke; and prompting multimethod bulk outreach to all patients on a smoking registry using an opt-out approach. EHR data were analyzed to assess CTIP reach and effectiveness among 6894 adult patients between January 2018 and February 2020. Cessation treatment reach increased significantly after CTIP launch in 5 of 6 clinics and was significantly higher when clinics were active vs. inactive in CTIP [Odds Ratio (OR) range = 2.0-3.0]. Rates of converting from current to former smoking status were also higher in active vs. inactive clinics (OR range = 2.2-10.5). Telephone treatment reach was particularly high in historically underserved groups, including African-American, Hispanic, and Medicaid-eligible patients. Implementation of a comprehensive, opt-out, chronic-care program aimed at all patients who smoke was associated with increases in the rates of pharmacotherapy and counseling delivery and quitting smoking. Proactive outreach may help reduce disparities in treatment access.
Subject(s)
Smoking Cessation , Tobacco Use Disorder , Adult , Humans , Tobacco Use Disorder/therapy , Electronic Health Records , Smoking Cessation/methods , Primary Health Care , Smoking/epidemiology , Smoking/therapyABSTRACT
Introduction: Most tobacco treatment efforts target healthcare settings, since 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 (TCOS) "cold-called" those without a primary care visit in the past year, offering tobacco dependence treatment. Age, sex, insurance status, race, ethnicity, 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 yrs., 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.