Impact of COVID-19 Pandemic on Assessing Tobacco Status in Community Health Centers

Flocke, Susan A.; Huguet, Nathalie; Bailey, Steffani R.; Hodes, Tahlia; O’Malley, Jean P.

doi:10.1370/afm.2948

Ann Fam Med

2023

DOI: 10.1370/afm.2948

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Impact of COVID-19 Pandemic on Assessing Tobacco Status in Community Health Centers

Susan A. Flocke

Nathalie Huguet²,

Steffani R. Bailey³

et al.

Abstract: Few have studied the COVID-19 pandemic's impact on tobacco use status assessment and cessation counseling. Electronic health record data from 217 primary care clinics were examined from January 1, 2019 to July 31, 2021. Data included telehealth and in-person visits for 759,138 adult patients (aged ≥18 years). Monthly rates of tobacco assessment per 1,000 patients were calculated. From March 2020 to May 2020, tobacco assessment monthly rates declined by 50% and increased from June 2020 to May 2021 but remained … Show more

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2024

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Smoking Assessment by Visit Modality Among Community-Based Primary Care Clinics

Bailey,

Lucas,

Holderness

et al. 2024

American Journal of Preventive Medicine

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Smoking Assessment by Visit Modality Among Community-Based Primary Care Clinics

Bailey,

Lucas,

Holderness

et al. 2024

American Journal of Preventive Medicine

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Association of COVID-19 and the Prevalence of In-person Versus Telehealth Primary Care Visits and Subsequent Impacts on Tobacco Use Assessment and Referral for Cessation Assistance

Flocke,

Albert,

Lewis

et al. 2024

Nicotine and Tobacco Research

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Introduction The COVID-19 pandemic dramatically altered patterns of health care delivery. Smoking remains an important risk factor for multiple chronic conditions and may exacerbate more severe symptoms of COVID-19. Thus, it is important to understand how pandemic-induced changes in primary care practice patterns affected smoking assessment and cessation assistance. Methods Electronic health record (EHR) data from 8 community health centers were examined from March 1, 2019 to February 28, 2022. Data include both telehealth (phone and video) and in-person office visits and represent 310,388 visits by adult patients. Rates of smoking assessment, provision of referral to counseling and orders for smoking cessation medications were calculated. Comparisons by visit mode and time period were examined using generalized estimating equations and logistic regression. Results The proportion of telehealth visits was <0.1% one year prior to COVID-19 onset and, 54.5% and 34.1% 1 and 2 years after. The odds of asking about smoking status and offering a referral to smoking cessation counseling were significantly higher during in-person vs. telehealth visits; AOR (95% CI) = 15.0 (14.7 –15.4) and AOR (95% CI)= 6.5 (3.0 – 13.9), respectively. The interaction effect of visit type * time period was significant for ordering smoking cessation medications. Conclusion Telehealth visits were significantly less likely to include smoking status assessment and referral to smoking cessation counseling compared to in-person visits. Given that smoking assessment and cessation assistance do not require face-to-face interactions with health care providers, continued efforts are needed to ensure provision at all visits, regardless of modality. Implications The COVID-19 pandemic dramatically altered patterns of health care seeking and delivery with a considerable rise in telehealth visits. This study examined one year prior to the onset of COVID-19 and two years after to evaluate the assessment of tobacco use and assistance with tobacco cessation and differences during in-person vs telehealth visits. Tobacco assessment was 15 times more likely during in-person vs. telehealth visits in the two years post onset of COVID-19. Given that telehealth visits are likely to continue, ensuring that patients are regularly assessed for tobacco regardless of visit modality is an important concern for health systems.

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Impact of COVID-19 Pandemic on Assessing Tobacco Status in Community Health Centers

Cited by 2 publications

References 17 publications

Smoking Assessment by Visit Modality Among Community-Based Primary Care Clinics

Smoking Assessment by Visit Modality Among Community-Based Primary Care Clinics

Association of COVID-19 and the Prevalence of In-person Versus Telehealth Primary Care Visits and Subsequent Impacts on Tobacco Use Assessment and Referral for Cessation Assistance

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