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Tobacco Screening and Treatment of Patients With a Psychiatric Diagnosis, 2012–2015

Published:September 27, 2019DOI:https://doi.org/10.1016/j.amepre.2019.06.009

      Introduction

      Smoking disproportionately affects individuals with psychiatric diagnoses. Providers can play a role in reducing tobacco-related morbidity among people with a psychiatric diagnosis by routinely screening and treating all patients for tobacco use. This study seeks to identify rates of tobacco screening, counseling, and medication orders during outpatient visits with adults who have a psychiatric diagnosis.

      Methods

      Data from the 2012–2015 National Ambulatory Medical Care Survey were examined to calculate the proportion of visits with people who have a psychiatric diagnosis that included tobacco screening, counseling, or smoking-cessation medications. Logistic regression was used to identify patient and visit factors associated with tobacco screening and treatment. All analyses were conducted in 2018.

      Results

      Seventy-two percent of visits included tobacco screening, 23% of visits with tobacco users included cessation counseling, and 4% of visits with tobacco users included a cessation medication order. Visits were more likely to include tobacco screening if they were for a nonpsychiatric condition, were >30 minutes, or were with a primary care physician (p<0.05). Visits were less likely to include tobacco screening if they were with a black, non-Hispanic patient or patient with Medicaid (p<0.05). Visits were more likely to include cessation counseling if they were for a nonpsychiatric condition (p<0.05), and were less likely to include counseling if they were with a Hispanic or self-pay patient (p<0.05).

      Conclusions

      There is still room for improvement in providing equitable treatment for people with psychiatric conditions for smoking, particularly in nonprimary settings.
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      REFERENCES

        • Mokdad AH
        • Marks JS
        • Stroup DF
        • Gerberding JL
        Actual causes of death in the United States, 2000.
        JAMA. 2004; 291: 1238-1245
        • Cook B
        • Wayne G
        • Kafali E
        • et al.
        Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation.
        JAMA. 2014; 311: 172-182
        • Tidey JW
        • Miller ME
        Smoking cessation and reduction in people with chronic mental illness.
        BMJ (Clin Res Ed). 2015; 351: h4065
        • Anthenelli RM
        • Morris C
        • Ramey TS
        • et al.
        Effects of varenicline on smoking cessation in adults with stably treated current or past major depression: a randomized trial.
        Ann Intern Med. 2013; 159: 390-400
        • Chengappa KN
        • Perkins KA
        • Brar JS
        • et al.
        Varenicline for smoking cessation in bipolar disorder: a randomized, double-blind, placebo-controlled study.
        J Clin Psychiatry. 2014; 75: 765-772
        • Evins AE
        • Cather C
        • Deckersbach T
        • et al.
        A double-blind placebo-controlled trial of bupropion sustained-release for smoking cessation in schizophrenia.
        J Clin Psychopharmacol. 2005; 25: 218-225
        • Gierisch JM
        • Bastian LA
        • Calhoun PS
        • McDuffie JR
        • Williams Jr, JW
        Smoking cessation interventions for patients with depression: a systematic review and meta-analysis.
        J Gen Intern Med. 2012; 27: 351-360
        • Fiore MC
        • Wetter DW
        • Bailey WC
        • et al.
        The Agency for Health Care Policy and Research Smoking Cessation clinical practice guideline.
        JAMA. 1996; 275: 1270-1280
        • Practice guideline for the treatment of patients with nicotine dependence
        American Psychiatric Association.
        Am J Psychiatry. 1996; 153: 1-31
        • Fiore MC
        U.S. Public Health Service clinical practice guideline: treating tobacco use and dependence.
        Respir Care. 2000; 45: 1200-1262
      1. Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence. Update. Clinical Practice Guideline. 2008, HHS, Public Health Service; Rockville, MD:www.ahrq.gov/sites/default/files/wysiwyg/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/treating_tobacco_use08.pdf. Accessed June 25, 2019.

        • Patient Protection and Affordable Care Act
        42 U.S.C. § 2713.
        Coverage of Preventive Services, 2010
        • Thorndike AN
        • Stafford RS
        • Rigotti NA
        U.S. physicians’ treatment of smoking in outpatients with psychiatric diagnoses.
        Nicotine Tob Res. 2001; 3: 85-91
        • Rogers E
        • Sherman S
        Tobacco use screening and treatment by outpatient psychiatrists before and after release of the American Psychiatric Association treatment guidelines for nicotine dependence.
        Am J Public Health. 2014; 104: 90-95
        • Samples H
        • Bandara S
        • Olfson M
        • Saloner B
        Tobacco screening and counseling in the U.S.: smokers with mental health and substance use problems.
        Am J Prev Med. 2018; 55: 524-532
      2. CDC, Ambulatory health care data, www.cdc.gov/nchs/ahcd.htm, Updated 2019. Accessed August 20, 2017.

        • Knox B
        • Mitchell S
        • Hernly E
        • et al.
        Barriers to utilizing Medicaid smoking cessation benefits.
        Kans J Med. 2017; 10: 1-11
        • Kahende J
        • Malarcher A
        • England L
        • et al.
        Utilization of smoking cessation medication benefits among Medicaid fee-for-service enrollees 1999–2008.
        PLoS One. 2017; 12: e0170381
        • Kwak MJ
        • Kim J
        • Bhise V
        • Chung TH
        • Petitto GS
        National trends in smoking cessation medication prescriptions for smokers with chronic obstructive pulmonary disease in the United States, 2007–2012.
        J Prev Med Public Health. 2018; 51: 257-262
        • Jackowski RM
        • Pogge EK
        • Early NK
        • Fairman KA
        • Sclar DA
        Provision of lifestyle counseling and the prescribing of pharmacotherapy for hyperlipidemia among U.S. ambulatory patients: a national assessment of office-based physician visits.
        Am J Cardiovasc Drugs. 2018; 18: 65-71
        • Kochanek KD
        • Xu JQ
        • Tejada-Vera B
        • Tejada-Vera B
        Deaths: final data for 2014.
        Natl Vital Stat Rep. 2016; 65: 1-122
      3. CDC. Tobacco-related disparities, www.cdc.gov/tobacco/disparities/index.htm, Updated March 7, 2018. Accessed June 21, 2019.

        • Jamal A
        • Dube SR
        • King BA
        Tobacco use screening and counseling during hospital outpatient visits among U.S. adults, 2005–2010.
        Prev Chronic Dis. 2015; 12 (140529)
        • Cokkinides VE
        • Halpern MT
        • Barbeau EM
        • Ward E
        • Thun MJ
        Racial and ethnic disparities in smoking-cessation interventions: analysis of the 2005 National Health Interview Survey.
        Am J Prev Med. 2008; 34: 404-412
        • Nelson KE
        • Hersh AL
        • Nkoy FL
        • et al.
        Primary care physician smoking screening and counseling for patients with chronic disease.
        Prev Med. 2015; 71: 77-82
        • Goldie CL
        • Malchy L
        • Johnson JL
        Facilitating knowledge translation in the “real world” of community psychiatry.
        J Am Psychiatr Nurs Assoc. 2010; 16: 339-344
        • Rogers ES
        • Gillespie C
        • Smelson D
        • Sherman SE
        A qualitative evaluation of mental health clinic staff perceptions of barriers and facilitators to treating tobacco use.
        Nicotine Tob Res. 2018; 20: 1223-1230
        • Twyman L
        • Bonevski B
        • Paul C
        • Bryant J
        Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature.
        BMJ Open. 2014; 4: e006414
        • Rogers ES
        Financial distress and smoking-induced deprivation in smokers with depression.
        Am J Health Behav. 2019; 43: 219-227
        • Steinberg ML
        • Williams JM
        • Ziedonis DM
        Financial implications of cigarette smoking among individuals with schizophrenia.
        Tob Control. 2004; 13 (206–206)
        • Rogers ES
        • Fu SS
        • Krebs P
        • et al.
        Proactive tobacco treatment for smokers using Veterans Administration mental health clinics.
        Am J Prev Med. 2018; 54: 620-629
        • Fu SS
        • van Ryn M
        • Sherman SE
        • et al.
        Proactive tobacco treatment and population-level cessation: a pragmatic randomized clinical trial.
        JAMA Intern Med. 2014; 174: 671-677
        • Gilchrist VJ
        • Stange KC
        • Flocke SA
        • McCord G
        • Bourguet CC
        A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits.
        Med Care. 2004; 42: 276-280