Point of care tobacco treatment sustains during COVID-19, a global pandemic

Craig, Ethan J.; Ramsey, Alex T.; Baker, Timothy B.; James, Aimee S.; Luke, Douglas A.; Malone, Sara; Chen, Jing-Ling; Pham, Giang; Smock, Nina; Goldberg, Paula B.; Govindan, Ramaswamy; Bierut, Laura J.; Chen, Li‐Shiun

doi:10.1016/j.canep.2021.102005

Cited by 9 publications

(15 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings argue for the critical importance to address barriers to healthcare with innovative sustainable solutions to limit rural disparity. One potential solution is to leverage the use of advancements in technology [ 36 , 37 ] such as, telehealth and telecommunication [ 38 , 39 ], health information technology, health management, decision support tools, patient education using outreach [ 40 – 42 ], and point of care models [ 5 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system

et al. 2022

Self Cite

View full text Add to dashboard Cite

Purpose The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system. Methods We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately. Findings Patients in rural clinics vs. urban clinics had worse health status [χ2 = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits. Conclusions Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.

show abstract

Section: Discussionmentioning

confidence: 99%

Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Our institution, in conjunction with our cancer centre (Siteman Cancer Center, St. Louis, Missouri, USA), instituted the Electronic Health Record-Enabled Evidence-based Smoking Cessation Treatment (ELEVATE) programme as part of the National Cancer Institute Cancer Moonshot Project and the Cancer Center Cessation Initiative (C3I) 17–19. The ELEVATE programme is a hospital-wide, point-of-care, low-burden, EHR-based tool for addressing smoking cessation which has demonstrated sustained efficacy, broad reach and reduced cost compared with other traditional models of tobacco treatment (ie, specialist referral) 18 20 21. As part of quality improvement initiatives for this programme, we collect several longitudinal data elements on patient smoking behaviours and treatment compliance in a centralised database.…”

Section: Methodsmentioning

confidence: 99%

“…The pharmacotherapies assessed were varenicline, bupropion (only if indicated for smoking deterrence) and NRT (gum, patch, inhaler, nasal spray or lozenge) 14. We also assessed whether patients were given behavioural support by extracting this information from the social history, tobacco use section, counselling flowsheets and best practice alerts, as previously described 20 21. Behavioural support included receipt of brief advice or referral to counselling through Quitlines, SmokefreeTXT or various phone applications (QuitGuide, QuitSTART and so on).…”

Section: Methodsmentioning

confidence: 99%

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

Heiden

Baker

Smock

et al. 2022

Thorax

Self Cite

View full text Add to dashboard Cite

BackgroundThe utility of electronic cigarettes (‘e-cigarettes’) as a smoking cessation adjunct remains unclear. Similarly, it is unclear if formal tobacco treatment (pharmacotherapy and/or behavioural support) augments smoking cessation in individuals who use both cigarettes and e-cigarettes.MethodsWe performed a longitudinal cohort study of adult outpatients evaluated in our tertiary care medical centre (6/2018–6/2020). E-cigarette use, smoking status and formal tobacco treatment (deterrent pharmacotherapy and/or behavioural support) were assessed in 6-month blocks (eg, cohort 1 (C1)=6/2018–12/2018, C2=1/2019–6/2019 and so on) using our electronic health record. We assessed the relationship between e-cigarette use (either with or without formal tobacco treatment) and point prevalence of smoking cessation at 6 and 12 months.Results111 823 unique patients were included in the study. The prevalence of dual use of cigarettes and e-cigarettes increased significantly over the study period (C1=0.8%; C2=1.1%; C3=1.8%; C4=2.3%; p<0.001). The prevalence of smoking cessation at 12 months was higher among e-cigarette users (20.8%) compared with non-users (16.8%) (risk difference, 4.0% (95% CI 2.5% to 5.5%); adjusted relative risk (aRR) 1.354, 95% CI 1.252 to 1.464, p<0.0001). Further, among dual users of cigarettes and e-cigarettes, the prevalence of smoking cessation at 12 months was higher among individuals who received tobacco treatment (29.1%) compared with individuals who did not receive tobacco treatment (19.6%) (risk difference, 9.5% (95% CI, 4.6% to 14.4%); aRR 1.238, 95% CI 1.071 to 1.432, p=0.004).InterpretationThese results suggest that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment. Clinicians should consider offering formal tobacco treatment to such patients, though future trials are needed.

show abstract

“…We assessed delivery of eight evidence-based tobacco treatment components (listed in Table 1). Point-of-care treatment included brief advice to quit smoking and discussion of evidence-based tobacco treatment options 15 delivered by a frontline oncology care provider (eg, oncologist or nurse) during routine oncology appointments.…”

Section: Evidence-based Treatment Componentsmentioning

confidence: 99%

Integrating Tobacco Treatment Into Oncology Care: Reach and Effectiveness of Evidence-Based Tobacco Treatment Across National Cancer Institute–Designated Cancer Centers

Hohl

Matulewicz

Salloum

et al. 2023

JCO

Self Cite

View full text Add to dashboard Cite

PURPOSE Quitting smoking improves patients' clinical outcomes, yet smoking is not commonly addressed as part of cancer care. The Cancer Center Cessation Initiative (C3I) supports National Cancer Institute–designated cancer centers to integrate tobacco treatment programs (TTPs) into routine cancer care. C3I centers vary in size, implementation strategies used, and treatment approaches. We examined associations of these contextual factors with treatment reach and smoking cessation effectiveness. METHODS This cross-sectional study used survey data from 28 C3I centers that reported tobacco treatment data during the first 6 months of 2021. Primary outcomes of interest were treatment reach (reach)—the proportion of patients identified as currently smoking who received at least one evidence-based tobacco treatment component (eg, counseling and pharmacotherapy)—and smoking cessation effectiveness (effectiveness)—the proportion of patients reporting 7-day point prevalence abstinence at 6-month follow-up. Center-level differences in reach and effectiveness were examined by center characteristics, implementation strategies, and tobacco treatment components. RESULTS Of the total 692,662 unique patients seen, 44,437 reported current smoking. Across centers, a median of 96% of patients were screened for tobacco use, median smoking prevalence was 7.4%, median reach was 15.4%, and median effectiveness was 18.4%. Center-level characteristics associated with higher reach included higher smoking prevalence, use of center-wide TTP, and lower patient-to-tobacco treatment specialist ratio. Higher effectiveness was observed at centers that served a larger overall population and population of patients who smoke, reported a higher smoking prevalence, and/or offered electronic health record referrals via a closed-loop system. CONCLUSION Whole-center TTP implementation among inpatients and outpatients, and increasing staff-to-patient ratios may improve TTP reach. Designating personnel with tobacco treatment expertise and resources to increase tobacco treatment dose or intensity may improve smoking cessation effectiveness.

show abstract

Point of care tobacco treatment sustains during COVID-19, a global pandemic

Cited by 9 publications

References 26 publications

Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system

Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

Integrating Tobacco Treatment Into Oncology Care: Reach and Effectiveness of Evidence-Based Tobacco Treatment Across National Cancer Institute–Designated Cancer Centers

Contact Info

Product

Resources

About