Steffani R. Bailey, John Heintzman, and Miguel Marino are with the Department of Family Medicine, Oregon Health & Science University, Portland, OR. John Heintzman, R. Lorie Jacob, and Jon Puro are with OCHIN Inc, Portland. Miguel Marino is also with Oregon Health & Science University-Portland State University School of Public Health, Division of Biostatistics, Portland.
Am J Public Health. 2018 Aug;108(8):1082-1090. doi: 10.2105/AJPH.2018.304492. Epub 2018 Jun 21.
To examine associations between patient factors and smoking cessation assistance in US safety-net clinics.
Using electronic health record data from the OCHIN network, we identified adults with at least 1 primary care visit to a study clinic (n = 143 clinics in 12 states) with at least 1 documented "current smoker" status during 2014 to 2016 (n = 136 314; 29.8%). We estimated odds ratios (ORs) of smoking cessation assistance receipt (none [reference], counseling, medication, or both) by patient covariates.
For all cessation assistance categories, odds of assistance were higher among women, those with more visits, those assessed and ready to quit, and patients with asthma or chronic obstructive pulmonary disease and hyperlipidemia. Odds of receiving both counseling and medication were lower among uninsured patients (OR = 0.56; 95% confidence interval [CI] = 0.48, 0.64), those of a race/ethnicity other than non-Hispanic White (OR range = 0.65-0.82), and those with diabetes (OR = 0.85; 95% CI = 0.79, 0.92), and higher among older patients and those with a comorbidity, with few exceptions.
Disparities in smoking cessation assistance receipt exist in safety-net settings, in particular by health insurance coverage and across race/ethnicity, even after control for other socioeconomic and demographic factors.
在美国医疗服务提供网络中，调查患者因素与戒烟辅助之间的关联。
我们使用 OCHIN 网络的电子健康记录数据，确定了在 2014 年至 2016 年期间至少有 1 次就诊于研究诊所（12 个州的 143 家诊所）并至少有 1 次记录为“当前吸烟者”状态的成年人（n=136314；29.8%）。我们通过患者特征来估计戒烟辅助（无[参照]、咨询、药物治疗或两者兼用）的接受率比值比（OR）。
在所有戒烟辅助类别中，女性、就诊次数更多、评估后准备戒烟、患有哮喘或慢性阻塞性肺疾病和高脂血症的患者，接受戒烟辅助的可能性更高。无保险的患者接受咨询和药物治疗的可能性较低（OR=0.56；95%置信区间[CI]：0.48，0.64），非西班牙裔白人以外的种族/民族的患者（OR 范围：0.65-0.82）和患有糖尿病的患者（OR=0.85；95%CI：0.79，0.92）接受咨询和药物治疗的可能性较低，而年龄较大的患者和患有合并症的患者接受咨询和药物治疗的可能性更高，除少数例外。
即使在控制了其他社会经济和人口统计学因素后，在医疗服务提供网络中仍然存在戒烟辅助接受率的差异，特别是在健康保险覆盖范围和种族/民族方面。
