Electronic medical record documentation of tobacco cessation support at eight community safety-net clinics with a high prevalence of tobacco use

Sue Flocke, Steve Lewis, Eileen Seeholzer, India Gill, Elizabeth Antognoli, Jeanmarie C. Rose, Thomas E. Love

Research output: Contribution to journalArticle

Abstract

Objectives: The high prevalence of tobacco use at primary care safety-net clinics represents an opportunity to offer assistance with cessation. Documentation of smoking status, offering advice and medications, and referral to cessation services are important steps in supporting cessation attempts and are required elements by payors and accrediting agencies to demonstrate care quality. This study examines tobacco cessation support rates and patient characteristics using electronic medical record (EMR) data. Methods: This cross-sectional study engaged eight community health centers affiliated with a county hospital system in NE Ohio where adult tobacco use rates exceed 30%. EMR data from June 2014 through May 2016 were analysed to assess rates of tobacco cessation counselling, order of cessation medications, or both. The association of tobacco cessation support with patient characteristics and quit attempts was assessed using multivariable logistic regression models. Results: Among 21 702 current tobacco users, 74% had no intervention documented; 15.4% had counselling documented, 6.4% were prescribed tobacco cessation medication, and 4.2% had both documented. Males, those aged 18 to 34, and African Americans were more likely to have no documented intervention. Of current tobacco users with at least two visits, 5.6% had a quit attempt. Medication alone was associated with a greater likelihood of a quit attempt (AOR: 1.72 [95% CI: 1.36-2.17]) as well as counselling and medication combined (AOR: 1.95 [95% CI: 1.48-2.56]). Conclusions: Tobacco cessation support was lacking for 74% of current smokers and was less likely in subgroups including males, younger adults, and African Americans. Ordering tobacco cessation medication combined with counselling nearly doubled the likelihood of a quit attempt.

Original languageEnglish (US)
JournalJournal of Evaluation in Clinical Practice
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Safety-net Providers
Tobacco Use Cessation
Electronic Health Records
Tobacco Use
Documentation
Counseling
African Americans
Tobacco
Logistic Models
County Hospitals
Community Health Centers
Quality of Health Care
Young Adult
Primary Health Care
Referral and Consultation
Cross-Sectional Studies
Smoking

Keywords

  • documentation
  • electronic health records
  • primary care
  • tobacco cessation support

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Electronic medical record documentation of tobacco cessation support at eight community safety-net clinics with a high prevalence of tobacco use. / Flocke, Sue; Lewis, Steve; Seeholzer, Eileen; Gill, India; Antognoli, Elizabeth; Rose, Jeanmarie C.; Love, Thomas E.

In: Journal of Evaluation in Clinical Practice, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Objectives: The high prevalence of tobacco use at primary care safety-net clinics represents an opportunity to offer assistance with cessation. Documentation of smoking status, offering advice and medications, and referral to cessation services are important steps in supporting cessation attempts and are required elements by payors and accrediting agencies to demonstrate care quality. This study examines tobacco cessation support rates and patient characteristics using electronic medical record (EMR) data. Methods: This cross-sectional study engaged eight community health centers affiliated with a county hospital system in NE Ohio where adult tobacco use rates exceed 30{\%}. EMR data from June 2014 through May 2016 were analysed to assess rates of tobacco cessation counselling, order of cessation medications, or both. The association of tobacco cessation support with patient characteristics and quit attempts was assessed using multivariable logistic regression models. Results: Among 21 702 current tobacco users, 74{\%} had no intervention documented; 15.4{\%} had counselling documented, 6.4{\%} were prescribed tobacco cessation medication, and 4.2{\%} had both documented. Males, those aged 18 to 34, and African Americans were more likely to have no documented intervention. Of current tobacco users with at least two visits, 5.6{\%} had a quit attempt. Medication alone was associated with a greater likelihood of a quit attempt (AOR: 1.72 [95{\%} CI: 1.36-2.17]) as well as counselling and medication combined (AOR: 1.95 [95{\%} CI: 1.48-2.56]). Conclusions: Tobacco cessation support was lacking for 74{\%} of current smokers and was less likely in subgroups including males, younger adults, and African Americans. Ordering tobacco cessation medication combined with counselling nearly doubled the likelihood of a quit attempt.",
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