Long-Term Outcomes From Repeated Smoking Cessation Assistance in Routine Primary Care

Bailey, Steffani R.; Stevens, Victor J.; Fortmann, Stephen P.; Kurtz, Stephen E.; McBurnie, Mary Ann; Priest, Elisa L.; Puro, Jon; Solberg, Leif I.; Schweitzer, Rebecca J.; Masica, Andrew L.; Hazlehurst, Brian

doi:10.1177/0890117118761886

Cited by 14 publications

(10 citation statements)

References 37 publications

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“…Our primary outcome was tobacco cessation ("quit") during the post-period, coded as a binary yes/ no variable. Using methods similar to prior EHR-based studies, 11,[19][20][21][22] a person was identified as "quit" if the last recorded tobacco-use status during the pre-period indicated that the patient was a current user, and if there was at least one subsequent measurement documented in the postperiod that indicated the patient's status was a "nonuser" (eg, former user, not a current user). We extracted the following tobacco cessation medications from EHR medication orders: bupropion, varenicline, and all nicotine replacement products; as a proxy for utilization of care, we extracted data on the number of post-period office visits per patient (≥6 vs. <6 visits) based on previous studies.…”

Section: Discussionmentioning

confidence: 99%

Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States

Bailey

Ezekiel-Herrera

Schmidt

et al. 2019

Nicotine &Amp; Tobacco Research

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Introduction Community health centers (CHCs) care for vulnerable patients who use tobacco at higher than national rates. States that expanded Medicaid eligibility under the Affordable Care Act (ACA) provided insurance coverage to tobacco users not previously Medicaid-eligible, thereby potentially increasing their odds of receiving cessation assistance. We examined if tobacco users in Medicaid expansion states had increased quit rates, cessation medications ordered, and greater health care utilization compared to patients in non-expansion states. Methods Using electronic health record (EHR) data from 219 CHCs in 10 states that expanded Medicaid as of January 1, 2014, we identified patients aged 19–64 with tobacco use status documented in the EHR within 6 months prior to ACA Medicaid expansion and ≥1 visit with tobacco use status assessed within 24 months post-expansion (January 1, 2014 to December 31, 2015). We propensity score matched these patients to tobacco users from 108 CHCs in six non-expansion states (n = 27 670 matched pairs; 55 340 patients). Using a retrospective observational cohort study design, we compared odds of having a quit status, cessation medication ordered, and ≥6 visits within the post-expansion period among patients in expansion versus non-expansion states. Results Patients in expansion states had increased adjusted odds of quitting (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI]: 1.28–1.43), having a medication ordered (aOR = 1.53, 95% CI: 1.44–1.62), and having ≥6 follow-up visits (aOR = 1.34, 95% CI: 1.28–1.41) compared to patients from non-expansion states. Conclusions Increased access to insurance via the ACA Medicaid expansion likely led to increased quit rates within this vulnerable population. Implications CHCs care for vulnerable patients at higher risk of tobacco use than the general population. Medicaid expansion via the ACA provided insurance coverage to a large number of tobacco users not previously Medicaid-eligible. We found that expanded insurance coverage was associated with increased cessation assistance and higher odds of tobacco cessation. Continued provision of insurance coverage could lead to increased quit rates among high-risk populations, resulting in improvements in population health outcomes and reduced total health care costs.

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Section: Discussionmentioning

confidence: 99%

Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States

Bailey

Ezekiel-Herrera

Schmidt

et al. 2019

Nicotine &Amp; Tobacco Research

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“…Indeed, repeated offerings of cessation support have been shown to increase positive smoking outcomes. 38,39 We will study this possibility with our longitudinal design.…”

Section: Discussionmentioning

confidence: 99%

“I Already Know That Smoking Ain’t Good for Me”

Golden

Ono

Melzer

et al. 2020

Chest

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“…As efforts in addressing diabetes, hypertension, depression, and HIV have all displayed success in improving health outcomes by using a chronic disease management framework, pairing smoking cessation with other chronic disease management efforts may help address racial/ethnic disparities in smoking outcomes. 20,24,25 Such interventions include telephone or in-person outreach to targeted populations, linking cessation counseling with efforts to improve blood pressure or diabetes care targets, or community engagement practices to inform cessation interventions. Latinx and Non-English speaking patients also had higher odds of recent cessation attempts, highlighting the importance of culturally informed and language concordant cessation counseling and resources.…”

Section: Discussionmentioning

confidence: 99%

“…32 Little is known about the rates of cessation attempts in primary care settings, with few studies estimating roughly 36-39% of patients making a recent cessation attempt and 15-20% of patients maintain cessation at one year. 24,25,33,34 Ours was one of the few studies evaluating cessation attempts and relapse rates at clinic or system levels within a safety-net system. Because most smokers who attempt cessation are likely to relapse with high average lifetime number of quit attempts before sustained cessation, 35,36 program initiatives should pay increasing attention toward sustaining cessation attempts and streamlining interventions to determine which groups require more intensive efforts.…”

Section: Discussionmentioning

confidence: 99%

Delivery of Smoking Cessation Services and Cessation Attempts Across a Public, Safety-Net Primary Care System

Suen¹,

Rafferty²,

Le³

et al. 2020

Preprint

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Background: Smoking cessation rates are low in safety-net settings, contributing to high smoking-related morbidity and mortality. Understanding factors associated with cessation attempts can inform interventions. Objective: To evaluate factors associated with smoking cessation attempts. Design: Retrospective analysis using electronic health record (EHR) data on individuals with at least three primary care encounters from 2016 to 2019 in the San Francisco Health Network (SFHN), a network of clinics serving publicly insured and uninsured residents in San Francisco.Participants: Patients engaged in primary care in the San Francisco Health Network.Main Measures: The outcome was recent cessation attempt, defined as change in smoking status from “current smoker” at the index visit to “former smoker” at visit 2 or 3. We measured demographics, tobacco-related comorbidities, and cessation treatment characteristics (i.e., counseling and pharmacotherapy). To better characterize subpopulations that may benefit from targeted interventions, we described characteristics of smokers with hypertension, depression, diabetes, or HIV.Key Results: Of the 51,554 adults identified across 15 SFHN primary care clinics, 11,622 (22.7%) were current smokers. Approximately 26% of smokers made a recent cessation attempt. Medical assistant (90%) and provider counseling (73%) rates were high, while behavioral assistant counseling rate (17%) was low. All counseling types had lower odds of cessation attempts in multivariable analysis. Smokers with depression (AOR 1.18, 95%CI 1.05-1.33) and ischemic heart disease (AOR 1.36, 95%CI 1.06-1.74) had higher odds of attempts. Among comorbidity groups, cessation attempts ranged from 21-26%, and smokers with HIV received the lowest rates of cessation counseling. Conclusions: Although rates of basic cessation counseling were high, efforts were associated with lower odds of making a cessation attempt. Using intensive interventions to target populations with comorbidities could be opportunities to increase cessation engagement.

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Long-Term Outcomes From Repeated Smoking Cessation Assistance in Routine Primary Care

Abstract: These findings provide support for the importance of repeated assistance at primary care visits to increase long-term smoking cessation.

Cited by 14 publications

References 37 publications

Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States

Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States

“I Already Know That Smoking Ain’t Good for Me”

Delivery of Smoking Cessation Services and Cessation Attempts Across a Public, Safety-Net Primary Care System

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