Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.
Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, USA.
J Eval Clin Pract. 2019 Jun;25(3):507-513. doi: 10.1111/jep.13069. Epub 2018 Nov 20.
The high prevalence of tobacco use at primary care safety-net clinics represents an opportunity to offer assistance with cessation. Documentation of smoking status, offering advice and medications, and referral to cessation services are important steps in supporting cessation attempts and are required elements by payors and accrediting agencies to demonstrate care quality. This study examines tobacco cessation support rates and patient characteristics using electronic medical record (EMR) data.
This cross-sectional study engaged eight community health centers affiliated with a county hospital system in NE Ohio where adult tobacco use rates exceed 30%. EMR data from June 2014 through May 2016 were analysed to assess rates of tobacco cessation counselling, order of cessation medications, or both. The association of tobacco cessation support with patient characteristics and quit attempts was assessed using multivariable logistic regression models.
Among 21 702 current tobacco users, 74% had no intervention documented; 15.4% had counselling documented, 6.4% were prescribed tobacco cessation medication, and 4.2% had both documented. Males, those aged 18 to 34, and African Americans were more likely to have no documented intervention. Of current tobacco users with at least two visits, 5.6% had a quit attempt. Medication alone was associated with a greater likelihood of a quit attempt (AOR: 1.72 [95% CI: 1.36-2.17]) as well as counselling and medication combined (AOR: 1.95 [95% CI: 1.48-2.56]).
Tobacco cessation support was lacking for 74% of current smokers and was less likely in subgroups including males, younger adults, and African Americans. Ordering tobacco cessation medication combined with counselling nearly doubled the likelihood of a quit attempt.
初级保健安全网诊所中烟草使用的高患病率代表了提供戒烟帮助的机会。记录吸烟状况、提供建议和药物治疗以及转介戒烟服务是支持戒烟尝试的重要步骤，也是支付方和认证机构为了展示医疗质量所需的要素。本研究使用电子病历（EMR）数据考察了戒烟支持率和患者特征。
本横断面研究纳入了俄亥俄州东北部一家县医院系统附属的 8 家社区卫生中心，该地区成年烟草使用率超过 30%。分析了 2014 年 6 月至 2016 年 5 月的 EMR 数据，以评估烟草戒断咨询、戒烟药物的开具顺序或两者兼有的戒烟支持率。使用多变量逻辑回归模型评估戒烟支持与患者特征和戒烟尝试的相关性。
在 21702 名当前烟草使用者中，74%的患者没有记录干预措施；15.4%的患者记录了咨询，6.4%的患者开具了烟草戒断药物，4.2%的患者同时记录了咨询和药物。男性、18 至 34 岁的人群和非裔美国人更有可能没有记录的干预措施。在至少有两次就诊的当前烟草使用者中，5.6%有戒烟尝试。单独使用药物与戒烟尝试的可能性增加相关（优势比：1.72[95%可信区间：1.36-2.17]），咨询和药物联合使用也与戒烟尝试的可能性增加相关（优势比：1.95[95%可信区间：1.48-2.56]）。
当前吸烟者中 74%的人缺乏戒烟支持，男性、年轻成年人和非裔美国人等亚组中这种情况更少见。同时开具烟草戒断药物和咨询几乎使戒烟尝试的可能性增加了一倍。
