Online Patient–Provider E-cigarette Consultations

Abstract

Introduction E-cigarettes are popular and unregulated. Patient–provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs. Methods An observational study of online patient–provider communications was conducted January 2011–June 2015 from a network providing free medical advice, and analyzed July 2014–May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function. Results An increase in e-cigarette–related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%), general safety (27%), e-cigarettes as quit aids (19%), comparison of e-cigarette harms relative to combusted tobacco (18%), use with pre-existing medical conditions (18%), and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers’ responses represented a negative attitude toward e-cigarettes, 33% were neutral (contradictory or non-committal), and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks. Conclusions Examination of online patient–provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare provider encouraged smoking cessation and recommended first-line cessation treatment approaches.

Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system

“…Incidence rates of patients' ENDS use based on clinician documentation in the EHR have increased dramatically in recent years, likely reflecting both surges in patient uptake of ENDS and greater patient-provider discussions about ENDS (Young-Wolff et al, 2017;Brown-Johnson et al, 2016). As expected, current smokers-and former smokers, to a lesser extent-had higher incidence rates of ENDS-use documentation each year than never-smokers.…”

Discussions between health professionals and smokers about nicotine vaping products: results from the 2016 ITC Four Country Smoking and Vaping Survey

“…Some research has shown that patient's questions about NVPs do not always directly relate to smoking cessation specifically, and can more generally be about the harm and safety of NVPs (including side effects, nicotine health risks and addiction issues). For example, one online study of licensed HPs from various disciplines found that half of providers reported having discussed vaping as a harm reduction option, while 26% discussed vaping as a quit aid . Our study suggests that HPs who are offering direct smoking cessation advice to their patients (and perhaps more regularly assess smoking status and cessation) may be more willing to recommend NVPs as a quit smoking aid.…”

“…Our findings showed that, overall, fewer than 10% of smokers reported having a discussion about NVPs with an HP in the last year. Moreover, a number of studies have shown that HPs are divided about recommending NVPs for smoking cessation . The results herein have shown that HPs rarely recommended NVPs to smokers (only 2% of smokers were encouraged to use an NVP, which was approximately a third among those who had a conversation about the topic).…”

“…The majority of research on HP–smoker discussions about NVPs comes from cross‐sectional and qualitative surveys of physicians. These studies have indicated that dialogues about NVPs have become increasingly frequent in clinical settings , are generally initiated by the patient , and typically do not end in a recommendation to use NVPs, apparently because most providers remain neutral or advise against use . To the best of our knowledge, only two studies have examined patient–physician NVP discussions from the patient's perspective .…”

Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults

“…Tracking ENDS use through routine documentation within healthcare visits could yield important surveillance data for studying population-level harm and harm reduction effects. National guidelines strongly recommend that tobacco screening in healthcare settings be expanded to include ENDS questions as part of standard health examinations (American Heart Association, 2016; The American Academy of Pediatrics Issues Sweeping Recommendations on Tobacco and E-Cigarettes, 2015), and healthcare providers are increasingly discussing ENDS use with patients (Nickels et al, 2016; Steinberg et al, 2015; Brown-Johnson et al, 2016). Routine clinician screening and documentation of ENDS use in the EHR could be linked to other healthcare data for retrospective and prospective analyses essential to assessing ENDS’ safety and harm reduction effectiveness.…”