Tobacco Use Prevalence and Outcomes Among Perinatal Patients Assessed Through an “Opt-out” Cessation and Follow-Up Clinical Program

Abstract

Purpose Cigarette smoking in the perinatal period is associated with costly morbidity and mortality for mother and infant, yet many women continue to smoke throughout their pregnancy and following delivery. This report describes tobacco use prevalence among perinatal smokers identified through an “opt-out” inpatient smoking cessation clinical service. Description Adult women admitted to the peripartum, delivery, and postpartum units at a large academic hospital were screened for tobacco use. Smokers were identified through their medical record and referred to a bedside consult and follow-up using an interactive voice response (IVR) system to assess smoking up to 30 days post-discharge. Assessment Between February 2014 and March 2016, 533 (10%) current and 898 (16%) former smokers were identified out of 5649 women admitted to the perinatal units. Current smokers reported an average of 11 cigarettes per day for approximately 12 years. Only 10% reported having made a quit attempt in the past year. The majority of smokers (56%) were visited by a bedside tobacco cessation counselor during their stay and 27% were contacted through the IVR system. Those counselled in the hospital were twice as likely (RR=1.98, CI=1.04–3.78) to be abstinent from smoking using intent-to-treat analysis at any time during the 30 days post-discharge. Conclusions This opt-out service reached a highly nicotine-dependent perinatal population, many of whom were receptive to the service, and it appeared to improve abstinence rates postdischarge. Opt-out tobacco cessation services may have a significant impact on the health outcomes of this population and their children.

Design and Pilot Implementation of an Electronic Health Record-Based System to Automatically Refer Cancer Patients to Tobacco Use Treatment

“…First, we utilized an "opt-out" approach to NDC referral without clinician involvement-all patients who acknowledge current tobacco are referred by default to the NDC, regardless of intent to stop. The main rationale for this recently proposed "opt-out" approach, which has shown promising early results [44], is that the efficacy of tobacco use interventions has little dependence on the intent to stop [45]. Operationally, this approach also has the advantage of not requiring the rooming staff who utilize the BPA to ascertain intent.…”

Assessing quality and agreement of structured data in automatic versus manual abstraction of the electronic health record for a clinical epidemiology study

“…These studies coincided with improved completion of smoking data in the EHR system, which was adopted for inpatients at MUSC during that time. [35][36][37] In addition to these initiatives at MUSC, the CMS criteria for meaningful use were in place prior to 2013, and documentation of patient smoking status, in addition to age, race, sex, ethnicity, and BMI, were already of high quality. 30 In contrast to the significant improvement observed in the quality of smoking data over time as shown in Table 3, no statistically significant improvement occurred over the same interval for Age (Figure 3) or Family History of Cancer, although the point estimate of agreement for positive family history of cancer appears to be higher in 2016 with more narrow confidence intervals.…”

Physician‐directed smoking cessation using patient “opt‐out” approach in the emergency department: A pilot program

“…23,24 Favorable outcomes have been reported for opt-out smoking cessation programs where bedside consults, referrals, and/or phone follow-up services were provided unless the patient objected in inpatient hospital settings, 25 and within populations of pregnant women. [26][27][28][29][30]…”

“…Unlike most other medical treatments, patients normally have to “opt in” to smoking cessation services based on their readiness to quit 23,24 . Favorable outcomes have been reported for opt‐out smoking cessation programs where bedside consults, referrals, and/or phone follow‐up services were provided unless the patient objected in inpatient hospital settings, 25 and within populations of pregnant women 26‐30 …”