Rheumatologists Modestly More Likely to Counsel Smokers in Visits Without Rheumatoid Arthritis Control

Abstract

Background Among patients with rheumatoid arthritis (RA), smoking increases risk for severe RA and pulmonary and cardiovascular disease (CVD). Despite this, little is known about smoking cessation counseling by rheumatologists. Objectives We examined predictors of tobacco counseling in RA patients who smoke including the effect of perceived RA control. We hypothesized that patients with controlled RA would receive more counseling according to the competing demands model, which explains that preventive care gaps occur as a result of competing provider, patient, and clinic factors. Methods This secondary data analysis involved RA patients with an additional CVD risk factor identified in an academic medical center 2004–2011. Trained abstractors assessed documented smoking counseling and rheumatologists’ impression of RA control in clinic notes. We used multivariable logistic regression to predict having received smoking cessation counseling, including sociodemographics and comorbidity in models. Results We abstracted 3,396 RA visits, including 360 visits (10%) with active smokers. Perceived controlled RA was present in 31% of visits involving smokers (39% in non-smokers). Beyond nurse documentation, providers documented smoking status in 39% of visit notes with smokers, and smoking cessation counseling in 10%. Visits with controlled versus active RA were less likely to include counseling (OR 0.3, CI 0.1–0.97). Counseling was more likely in visits with prevalent cardiovascular, pulmonary, and psychiatric disease, but decreased with obesity. Conclusions Smoking cessation counseling was documented in 10% of visits and was less likely when RA was controlled. Given smoking’s impact on RA and long-term outcomes, systematic cessation counseling efforts are needed.

Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the EUREST-PLUS ITC Europe Surveys

“…Smokers with chronic respiratory diseases did indeed receive smoking cessation support more often than smokers without diseases. It seems that the existence of chronic respiratory disease may increase physician engagement in cessation as smokers with respiratory disease received support more often than smokers with other chronic non-respiratory diseases, in accordance with other studies 16-18 . Smokers with respiratory disease may contemplate quitting smoking and therefore request advice and support from healthcare professionals more often than smokers without any diseases.…”

“…Current research suggests that physician assistance in smoking cessation (i.e. brief counseling and pharmacotherapy) may be increased among smokers with chronic diseases than smokers without diseases 16-18 . Amongst sociodemographic factors that have been found to influence smoking behavior and cessation assistance are age, income, and educational level 19-21 .…”

Frequency and Predictors of Communication About High Blood Pressure in Rheumatoid Arthritis Visits

“…In a prior study, we also noted lower rates of incident hypertension diagnosis in RA patients than peers, with particularly low rates in RA patients who currently use tobacco [31]. In another study, we also reported that only 10% of encounters with RA patients who smoked documented cessation counselling[32] suggesting that competing priorities alone did not explain gaps in CVD risk factor counselling for either hypertension or smoking cessation. Likewise, noting more BP-communication after CVD events highlights a missed opportunity to reduce CVD by addressing modifiable risk factors like hypertension before events occur.…”

Interactive Participatory Audit and Feedback (IPAF): Theory-based development and multi-site implementation outcomes with specialty clinic staff

“…[10] In specialty clinics, however, clinicians discuss CVD risk factors such as BP or tobacco in only 10% of relevant specialty visits, despite routinely assessing them. [11,12] Non-vascular specialty clinics have not implemented protocols to address high BP and tobacco use, which are the most prevalent risk factors for CVD in US adults. In particular, although many rheumatology populations face increased in ammatory CVD risks, [13] rheumatologists typically consider addressing CVD risk factors to be outside their scope of practice.…”