Variation in Patient Smoking Cessation Rates Among Health-Care Providers
| Autor: | Elizabeth L. Ciemins, Anupama Arora, Vaishali Joshi, Saja Almaaitah, Michael B. Rothberg, Christopher Meskow |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
COPD medicine.medical_specialty business.industry media_common.quotation_subject medicine.medical_treatment Retrospective cohort study Abstinence Critical Care and Intensive Care Medicine medicine.disease Logistic regression 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Family medicine Health care medicine Smoking cessation Observational study 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Medicaid media_common |
| Zdroj: | Chest. 158:2038-2046 |
| ISSN: | 0012-3692 |
| Popis: | Background Physicians play a crucial role in providing smoking cessation counseling and medications. However, it is unknown whether individual physicians' approaches affect whether patients quit. Research Question This study assessed patient quit rates within a national quality-improvement learning collaborative to document variation in quit rates at the physician, practice, and health system levels. Study Design and Methods A retrospective cohort study was conducted of primary care patients identified from the Optum analytics database containing longitudinal ambulatory data for patients from 22 health-care organizations between January 2012 and December 2018. The study included smokers aged ≥ 18 years who attended at least three ambulatory visits, with two visits at least 1 year apart. The primary study outcome was abstinence for ≥ 1 year. A mixed effects logistic regression model was used to predict the probability of quitting as a function of patient variables. Quit rates were then adjusted by patient factors and calculated at the level of clinician, clinic/practice, and health system. Results Across all systems, 56% of patients had a documented smoking status in 2017. Among nearly 1 million smokers, 24% quit smoking. In the regression model, patient characteristics associated with quitting included older age, Hispanic ethnicity, being married, urban residence, commercial insurance, pregnancy, and a diagnosis of pneumonia, myocardial infarction, ischemic heart disease, cataract, or asthma. Medicaid insurance, low income, high BMI, peripheral vascular disease, alcohol-related diagnosis, and COPD were negatively associated with smoking cessation. Adjusted quit rates ranged from 14.3% to 34.5% across 20 health systems, 5% to 66% among 1,399 practice sites, and 4% to 87% among 3,803 health-care providers. Of smokers, 10.2% were prescribed smoking deterrents, and 3.9% were referred for counseling. Interpretation Smoking cessation rates varied substantially at the practitioner, practice site, and health system levels. It is likely that individual physician approaches to smoking cessation influence patients' likelihood of quitting. |
| Databáze: | OpenAIRE |
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