Healthcare visits by smokers: Does cessation treatment differ based on clinical condition?

INTRODUCTION: Persons with behavioral health conditions are disproportionally burdened by their tobacco use. Research is limited on how often this patient population is offered tobacco cessation interventions at healthcare visits. This study examines if cessation treatment offered at healthcare visits differs based on the clinical condition. METHODS: Using data from the 2015-2018 National Ambulatory Medical Care Survey (NAMCS), we examined tobacco cessation counseling and medications (bupropion, nicotine replacement therapies and varenicline) from 4,590 visits by patients with current tobacco use. Separate multivariate logistic regressions were used to assess whether the odds of receiving tobacco cessation treatment varied by three groups of clinical conditions: (1) substance use disorder and/or alcohol use disorder, (2) depression, and (3) physical conditions. RESULTS: The odds of being offered smoking cessation counseling are 4.02 times greater for visits by patients with substance use disorder and/or alcohol use disorder compared to visits by patients with depression (p<.001), while the odds of receiving smoking cessation medication are 2.36 times greater for visits by patients with depression compared to visits by patients with substance use disorder and/or alcohol use disorder (p<.01). Visits by patients with substance use disorder and/or alcohol use disorder have 2.36 times the odds of receiving any combination of tobacco cessation treatment compared to visits by patients with depression (p<.001). CONCLUSIONS: Providers are offering cessation treatment at visits by patients with behavioral health conditions at either higher or comparable rates to those without, however, tobacco cessation treatment continues to be underutilized by providers during office visits. IMPLICATIONS: The results of our study have implications for increasing educational opportunities for healthcare providers to improve their confidence in offering tobacco cessation treatment to patients with behavioral health conditions. These patients are motivated to quit smoking, yet cessation treatment is underutilized in this population despite having a greater health effect than most other clinical interventions. Incorporating tobacco cessation education in medical school curricula and post-graduate training can help eliminate barriers for physicians to routinely provide cessation assistance. Collaboration between clinicians and behavioral health providers can also enhance tobacco treatment support and improve cessation rates.

Racial and Ethnic Differences in Emergency Department Wait Times for Patients with Substance Use Disorder.

BACKGROUND: Substance use-related morbidity and mortality rates are at an all-time high in the United States, yet there remains significant stigma and discrimination in emergency medicine about patients with this condition. OBJECTIVES: The purpose of this study was to determine whether there are racial and ethnic differences in emergency department (ED) wait times among patients with substance use disorder. METHODS: The study uses pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016 to 2018. The dependent variable is length of time the patient with a diagnosis of substance use disorder waited in the ED before being admitted for care. The independent variable is patient race and ethnicity. Adjusted analyses were conducted using a generalized linear model. RESULTS: There were a total of 3995 reported ED events among patients reporting a substance use disorder in the NHAMCS sample between 2016 and 2018. After adjusting for covariates, Black patients with substance use disorder were significantly more likely to wait longer in the ED (35% longer) than White patients with substance use disorder (p < 0.01). CONCLUSIONS: The findings showed that Black patients with substance use disorder are waiting 35% longer, on average, than White patients with the same condition. This is concerning, given that emergency medicine is a critical frontline of care, and often the only source of care, for these patients. Furthermore, longer wait times can increase the likelihood of leaving the ED without being seen. Programs and policies should address potential stigma and discrimination among providers, and EDs should consider adding people with lived experiences to the staff to serve as peer recovery specialists and bridge the gap for care.

Tobacco Cessation Counseling and Medications Provided by Physicians to Tobacco Users During Primary Care Visits.

INTRODUCTION: The established guidelines for treating tobacco use and dependency is brief provider intervention to assist those willing to quit by providing access to medication and/or behavioral counseling. The purpose of the study is to determine the extent of cessation treatment offered by providers during primary care visits by patients who are current tobacco users, and to examine associations between patient factors and treatment received. METHODS: Using data from the 2015 to 2018 National Ambulatory Medical Care Survey (NAMCS), we examined tobacco cessation counseling and medications from 4590 visits by patients with current tobacco use. Separate multivariate logistic regressions were used to assess whether the odds of receiving tobacco cessation treatment varied by age, gender, race/ethnicity, and payment source. RESULTS: Of visits by current tobacco users, 18.4% included cessation counseling, 5.5% included cessation medication, and 22.1% included at least 1 type of treatment. Visits by patients with Medicare had 44% greater odds of including counseling (CI = 1%-205%) and treatment (OR = 1.44; 95% CI = 1.01-2.06). Visits classified as "other payment type" had 73% greater odds of including counseling (OR = 1.73; 95% CI = 1.05-2.84). Visits by women had 86% greater odds of including medication (CI = 17%-294%). CONCLUSIONS: Tobacco cessation treatment is underutilized by providers during primary care visits. Further research is necessary to understand and address barriers to providing routine cessation assistance.

Student and Preceptor Perceptions of the Summer Clinical Practicum: An Assessment of the First Year Clinical Skills Capstone.

This article was migrated. The article was marked as recommended. Objective: As the first new medical school chartered in the 21 st century, FSUCOM adopted a unique approach to medical education. Beyond the expected basic science courses, first year students participate in a year-long Doctoring and Clinical Skills Course. The first year culminates in a three week Summer Clinical Practicum (SCP) emphasizing mission centric populations. We designed a survey to assess medical student and clinical preceptor impressions of the SCP for purposes of quality improvement. Methods: Students in their second, third, and fourth years and their preceptors were included in a cross sectional descriptive study. All participants responded to an electronic web based survey developed and administered in Summer 2016. The overall student response rate was 32%, while 53% of preceptors participated. Results: Survey results indicated that the SCP first year capstone experience is highly valued by students and preceptors alike. We found a high concordance of perceptions between student cohorts spanning three years and faculty preceptor respondents. For purposes of programmatic planning and quality improvement there was strong support for maintaining the current length for the SCP at three weeks. Additionally, survey findings appear to support ongoing perceived benefit from the early clinical exposure summer experience, with students agreeing that the SCP helped focus their learning as M-2s, and influenced their readiness for subsequent clinical clerkships. Conclusion: Our study supports the growing body of knowledge that early clinical experience for matriculating medical students is not only feasible, but desirable, and has lasting effects throughout their undergraduate medical education.

Medical Residents' and Practicing Physicians' e-Cigarette Knowledge and Patient Screening Activities: Do They Differ?

PURPOSE: The purpose of this study was to compare medical residents and practicing physicians in primary care specialties regarding their knowledge and beliefs about electronic cigarettes (e-cigarettes). We wanted to ascertain whether years removed from medical school had an effect on screening practices, recommendations given to patients, and the types of informational sources utilized. METHODS: A statewide sample of Florida primary care medical residents (n = 61) and practicing physicians (n = 53) completed either an online or paper survey, measuring patient screening and physician recommendations, beliefs, and knowledge related to e-cigarettes. χ2 tests of association and linear and logistic regression models were used to assess the differences within- and between-participant groups. RESULTS: Practicing physicians were more likely than medical residents to believe e-cigarettes lower cancer risk in patients who use them as an alternative to cigarettes (P = .0003). Medical residents were more likely to receive information about e-cigarettes from colleagues (P = .0001). No statistically significant differences were observed related to e-cigarette knowledge or patient recommendations. CONCLUSIONS: Practicing primary care physicians are accepting both the benefits and costs associated with e-cigarettes, while medical residents in primary care are more reticent. Targeted education concerning the potential health risks and benefits associated with the use of e-cigarettes needs to be included in the current medical education curriculum and medical provider training to improve provider confidence in discussing issues surrounding the use of this product.

Adolescent cigarette smokers' and non-cigarette smokers' use of alternative tobacco products.

INTRODUCTION: This study uses the most recent data from the nationally representative National Youth Tobacco Survey (NYTS) to examine the use of alternative tobacco products among U.S. cigarette smokers and non-cigarette smokers aged 14-17. Alternative tobacco product use is defined as use of one or more of the following products: smokeless tobacco, cigars, pipes, bidis, or kreteks. METHODS: Using the results from the 2004, 2006, and 2009 NYTS, multivariate logistic regressions were used to investigate separately the extent of alternative tobacco product use in current cigarette smokers and in those who reported not smoking cigarettes controlling for demographic and other independent influences. RESULTS: The results indicate that for adolescent smokers and nonsmokers, the use of one type of alternative tobacco product made it much more likely the individual would use one or more of the other alternative tobacco products. Non-cigarette smokers using these tobacco products appeared to exhibit symptoms of nicotine dependence comparable to those of cigarette smokers. CONCLUSIONS: More information on adolescent use of alternative tobacco products is needed. Current cigarette use declined 3.4% annually over 2004-2009 for the NYTS 14- to 17-year-old population, but this cohort's use of alternative tobacco products was unchanged. The number of adolescents aged 14-17 who did not smoke cigarettes but used alternative tobacco products increased 5.9% per year over the same period. Current surveillance measures need to be expanded in order to gain a more comprehensive understanding of adolescent alternative tobacco use.

Reducing the impact of the health care access crisis through volunteerism: a means, not an end.

In the absence of meaningful health reform, Florida implemented a volunteer health care program to strengthen the existing safety net. Since program implementation in 1992, over $1 billion of services have been provided to uninsured and underserved populations. Currently, over 20,000 volunteers participate statewide. Key incentives for provider participation have been an organized framework for volunteering and liability protection through state-sponsored sovereign immunity. Volunteerism, although not a solution to the health care crisis, serves as a valuable adjunct pending full-scale health care reform.