BACKGROUND: Physicians play a critical role in tobacco-dependence treatment, especially prescribing cessation medications. However, it is unclear whether efforts are meeting recommended standards. This study evaluates the frequency and predictors of tobacco-use identification, counseling for tobacco dependence, and the prescription of cessation medications in a nationally representative sample of physician-patient encounters. METHODS: More than 58,000 physician-patient ambulatory encounters from the National Ambulatory Medical Care Survey 2001 and 2002 were analyzed in 2004-2005, including patient demographics, diagnoses, tobacco counseling, and prescriptions. RESULTS: Tobacco-use status was identified in 69% of patient encounters, with 16% of those encounters indicating current use. Tobacco counseling occurred in 22.5% of visits by tobacco users, and 2.4% of tobacco users were prescribed cessation medications. These rates are similar to previous analyses in 1991. Patient characteristics associated with being more likely to receive counseling include being a new patient (adjusted odds ratio [OR]=1.34, 95% confidence interval [CI]=1.00-1.77) and having a tobacco-caused diagnosis (OR=2.71, CI=1.95-3.78). Characteristics associated with a lower likelihood of receiving medication include female gender (OR=0.45, CI=0.22-0.90) and age 65 and above (OR=0.14, CI=0.03-0.63), while a tobacco-caused diagnosis (OR=3.91, CI=1.64-9.29) and patient prompting (OR=15.31, CI=3.36-69.8) were associated with higher likelihood of receiving medications. CONCLUSIONS: Despite increasing national attention, the identification of tobacco status, counseling rates, and the use of cessation medications by physicians are low and unchanged from 1991. Women and elderly tobacco users were much less likely to receive prescriptions for cessation medications, while patients requesting treatment and those with tobacco-caused diagnoses were more likely. Further educational and public health campaigns are needed to encourage the use of these effective medications, especially in women and the elderly.
BACKGROUND: Physicians play a critical role in tobacco-dependence treatment, especially prescribing cessation medications. However, it is unclear whether efforts are meeting recommended standards. This study evaluates the frequency and predictors of tobacco-use identification, counseling for tobacco dependence, and the prescription of cessation medications in a nationally representative sample of physician-patient encounters. METHODS: More than 58,000 physician-patient ambulatory encounters from the National Ambulatory Medical Care Survey 2001 and 2002 were analyzed in 2004-2005, including patient demographics, diagnoses, tobacco counseling, and prescriptions. RESULTS:Tobacco-use status was identified in 69% of patient encounters, with 16% of those encounters indicating current use. Tobacco counseling occurred in 22.5% of visits by tobacco users, and 2.4% of tobacco users were prescribed cessation medications. These rates are similar to previous analyses in 1991. Patient characteristics associated with being more likely to receive counseling include being a new patient (adjusted odds ratio [OR]=1.34, 95% confidence interval [CI]=1.00-1.77) and having a tobacco-caused diagnosis (OR=2.71, CI=1.95-3.78). Characteristics associated with a lower likelihood of receiving medication include female gender (OR=0.45, CI=0.22-0.90) and age 65 and above (OR=0.14, CI=0.03-0.63), while a tobacco-caused diagnosis (OR=3.91, CI=1.64-9.29) and patient prompting (OR=15.31, CI=3.36-69.8) were associated with higher likelihood of receiving medications. CONCLUSIONS: Despite increasing national attention, the identification of tobacco status, counseling rates, and the use of cessation medications by physicians are low and unchanged from 1991. Women and elderly tobacco users were much less likely to receive prescriptions for cessation medications, while patients requesting treatment and those with tobacco-caused diagnoses were more likely. Further educational and public health campaigns are needed to encourage the use of these effective medications, especially in women and the elderly.
Authors: Megan E Piper; Jessica W Cook; Tanya R Schlam; Douglas E Jorenby; Stevens S Smith; Daniel M Bolt; Wei-Yin Loh Journal: Nicotine Tob Res Date: 2010-05-03 Impact factor: 4.244
Authors: Esther K Choo; Gillian Beauchamp; Francesca L Beaudoin; Edward Bernstein; Judith Bernstein; Steven L Bernstein; Kerryann B Broderick; Robert D Cannon; Gail D'Onofrio; Marna R Greenberg; Kathryn Hawk; Rashelle B Hayes; Gabrielle A Jacquet; Melanie J Lippmann; Karin V Rhodes; Susan H Watts; Edwin D Boudreaux Journal: Acad Emerg Med Date: 2014-12-01 Impact factor: 3.451
Authors: Quinn S Wells; Matthew S Freiberg; Robert A Greevy; Rachel F Tyndale; Suman Kundu; Meredith S Duncan; Stephen King; Lesa Abney; Elizabeth Scoville; Dawn B Beaulieu; Vanessa Gatskie; Hilary A Tindle Journal: Nicotine Tob Res Date: 2018-11-15 Impact factor: 4.244
Authors: Jennifer Dahne; Amy E Wahlquist; Elizabeth Garrett-Mayer; Bryan W Heckman; K Michael Cummings; Matthew J Carpenter Journal: Prev Med Date: 2017-10-05 Impact factor: 4.018