Flocke Susan A, Albert Elizabeth L, Lewis Steven A, Seeholzer Eileen L, Bailey Steffani R
Department of Family Medicine, Oregon Health and Sciences University, Portland, OR, USA.
Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA.
Nicotine Tob Res. 2024 Oct 22;26(11):1563-1569. doi: 10.1093/ntr/ntae126.
The COVID-19 pandemic dramatically altered patterns of healthcare delivery. Smoking remains an important risk factor for multiple chronic conditions and may exacerbate more severe symptoms of COVID-19. Thus, it is important to understand how pandemic-induced changes in primary care practice patterns affected smoking assessment and cessation assistance.
Electronic health record data from eight community health centers were examined from March 1, 2019 to February 28, 2022. Data include both telehealth (phone and video) and in-person office visits and represent 310 388 visits by adult patients. Rates of smoking assessment, provision of referral to counseling, and orders for smoking cessation medications were calculated. Comparisons by visit mode and time period were examined using generalized estimating equations and logistic regression.
The proportion of telehealth visits was < 0.1% 1 year prior to COVID-19 onset and, 54.5% and 34.1% 1 and 2 years after. The odds of asking about smoking status and offering a referral to smoking cessation counseling were significantly higher during in-person versus telehealth visits; adjusted odds ratios (AOR) (95% CI) = 15.0 (14.7 to 15.4) and AOR (95% CI) = 6.5 (3.0 to 13.9), respectively. The interaction effect of visit type * time period was significant for ordering smoking cessation medications.
Telehealth visits were significantly less likely to include smoking status assessment and referral to smoking cessation counseling compared to in-person visits. Given that smoking assessment and cessation assistance do not require face-to-face interactions with health care providers, continued efforts are needed to ensure provision at all visits, regardless of modality.
The COVID-19 pandemic dramatically altered patterns of healthcare-seeking and delivery with a considerable rise in telehealth visits. This study examined 1 year prior to the onset of COVID-19 and 2 years after to evaluate the assessment of tobacco use and assistance with tobacco cessation and differences during in-person versus telehealth visits. Tobacco assessment was 15 times more likely during in-person versus telehealth visits in the 2 years post onset of COVID-19. Given that telehealth visits are likely to continue, ensuring that patients are regularly assessed for tobacco regardless of visit modality is an important concern for health systems.
新冠疫情极大地改变了医疗服务模式。吸烟仍是多种慢性病的重要风险因素，且可能加重新冠更严重的症状。因此，了解疫情引发的初级保健实践模式变化如何影响吸烟评估和戒烟援助非常重要。
研究分析了2019年3月1日至2022年2月28日期间8家社区卫生中心的电子健康记录数据。数据包括远程医疗（电话和视频）及面对面门诊就诊情况，涵盖成年患者的310388次就诊。计算了吸烟评估率、提供咨询转诊率以及戒烟药物处方率。使用广义估计方程和逻辑回归对就诊模式和时间段进行比较分析。
在新冠疫情开始前1年，远程医疗就诊比例<0.1%，在疫情开始后1年和2年分别为54.5%和34.1%。与远程医疗就诊相比，面对面就诊时询问吸烟状况并提供戒烟咨询转诊的几率显著更高；调整后的优势比（AOR）（95%置信区间）分别为15.0（14.7至15.4）和AOR（95%置信区间）=6.5（3.0至13.9）。就诊类型*时间段的交互作用对开具戒烟药物具有显著影响。
与面对面就诊相比，远程医疗就诊进行吸烟状况评估和转诊戒烟咨询的可能性显著更低。鉴于吸烟评估和戒烟援助并不需要与医疗服务提供者进行面对面互动，因此需要持续努力确保在所有就诊中提供相关服务，无论就诊方式如何。
新冠疫情极大地改变了就医和医疗服务模式，远程医疗就诊显著增加。本研究在新冠疫情开始前1年及之后2年进行，以评估烟草使用评估和戒烟援助情况以及面对面就诊与远程医疗就诊之间的差异。在新冠疫情开始后的2年里，面对面就诊时进行烟草评估的可能性比远程医疗就诊高15倍。鉴于远程医疗就诊可能会持续，确保无论就诊方式如何都对患者进行定期烟草评估是卫生系统的一个重要关注点。
