Evaluating a Tobacco Treatment Program’s Transition to Telehealth Using a Social Determinants of Health Lens

Abstract

Introduction While strong associations exist between social determinants of health (SDOH), socioeconomic status, and smoking, these factors are not routinely assessed in tobacco treatment programs. This study addresses this gap by evaluating a composite metric of SDOH and a measure of access to care to determine program reach before and after implementation of telehealth tobacco treatment delivery. Methods We examined inpatient data from a large tobacco treatment program during two comparable time periods 04/01/2019-09/30/2019 (pre-telehealth) and 04/01/2020-09/30/2020 (telehealth). The populations were compared using point of care data, including five-digit zip codes mapped to the CDC’s Social Vulnerability Index (SVI) and driving distance (in 60-minute increments) to the study hospital. Chi-square tests for homogeneity were performed for SVI and driving distance comparisons. Results While distance distributions were significantly different between the pre-telehealth and telehealth populations (χ2=13.5df=3, N=3234, P=.004), no significant differences existed in the proportion of SVI categories between the two populations (χ2=5.8df=3, N=3234, P=.12). In the telehealth population, patients with the highest SVI vulnerability had the greatest proportions living > one hour from the hospital. Conclusions This study offers a novel evaluation of tobacco treatment in relation to an SDOH metric (SVI) and care access (distance to the hospital) for inpatient populations. Patient reach, including to those with high vulnerabilities, remained consistent in a transition to telehealth. These methods can inform future reach and engagement of patients who use tobacco products, including patients with high vulnerability or who reside at greater distances from treatment programs. Implications This study provides the first analysis of inpatient tobacco use treatment transition to telehealth delivery of care during the COVID-19 pandemic using the CDC’s SVI metric and patient distance to the hospital. The transition resulted in consistent reach to patients at the highest vulnerability. These findings can inform efforts to evaluate SDOH measures and improve reach, engagement, and research on telehealth delivery of inpatient tobacco use treatment.