Use of electronic health records to manage tobacco screening and treatment in rural primary care

Abstract

Purpose: Electronic health records (EHRs) can facilitate primary care providers' (PCPs) use of best practices in addressing tobacco dependence. It is unknown whether rural PCPs reap the same benefits as their urban counterparts when employing EHRs for this purpose. Our study examines this issue.Methods: This cross-sectional investigation based on the 2012-2015 National Ambulatory Medical Care Survey used chi-square tests and adjusted logistic regression models to explore how rurality and use of tobacco-related EHR functions were related to smoking status documentation (SSD) and cessation treatment at adult primary care visits.Findings: SSD rates were similar in visits to rural-and urban-based PCPs (88.2% ruralbased vs 81.1% urban-based, P = .5819). Use of EHRs for SSD was associated with higher SSD odds at visits to both rural-and urban-based PCPs, but this increase was greater for visits to rural-based PCPs (428% vs 220% urban-based, P = .0443). Rates of cessation treatment at smokers' visits were low in rural and urban contexts (19.3% rural vs 19.6% urban, P = .9430). Odds of cessation treatment were 68% higher where EHRs were used to remind PCPs of treatment guidelines (P = .001), with no rural-urban difference in the size of the increase. Access to EHRs with tobacco-related functions was similar across rural and urban practices. Conclusions:Rural-based PCPs were at least as successful as urban-based PCPs in leveraging EHRs to enhance tobacco-related services. Even where EHRs are used, opportunities exist to expand cessation treatment in rural primary care.

An “Engage to Sustain” Intervention to Improve Process Performance Measures in Ambulatory Care

“…Our average tobacco use screening rate across postintervention quarters was 72.04%, within the range of national studies, 63.0% of visits (N = estimated 271 million) to 81.1% of visits (N = 61 686) for urban-based practices (Jamal et al, 2015; Talbot et al, 2022). The final compliance rate with offering tobacco cessation counseling did rise from 4.3% to 22.4% with a postintervention average of 17%.…”

“…The final compliance rate with offering tobacco cessation counseling did rise from 4.3% to 22.4% with a postintervention average of 17%. Others documented 19.6% to 24.5% for ambulatory care providers offering smoking cessation counseling (Jamal et al, 2015; Talbot et al, 2022). The inability to reach higher compliance rates with distributing written materials may be influenced by a number of factors such as resources offered at previous visits, patient not ready, patient declined counseling, time constraints, assumptions that providers would address counseling, or simply forgetting.…”

“…Low rates for this measure prompted revisions to educational content and practice resources (eg, tip sheet) and plans to enhance practice advisories in the EHR. The odds of smoking cessation treatment are much higher with EHR reminders and prompts (Talbot et al, 2022).…”

“…National studies on tobacco use (cigarettes, cigars, snuff, or chewing) screening rates in ambulatory care rose from an average of 63% during 2005-2010 to 81.1% in urban-based settings and 88.2% in rural-based settings from 2012 to 2015 (Jamal et al, 2015; Talbot et al, 2022). Others corroborate higher rates of tobacco screening practices and cessation-directed advice and interventions with surveys of primary care providers (Kruger et al, 2015).…”