Tobacco Cessation Medications Research Articles

An opt-out tobacco treatment group intervention within an intensive substance use disorders treatment program: Initial outcomes in the Veterans Health Administration.

Despite steadily declining rates of tobacco use in the United States, individuals suffering from substance use disorders (SUD) and other mental illnesses continue to use tobacco at alarmingly high rates, resulting in increased mortality. Given the synergistic consequences to those who suffer from both tobacco use disorders (TUD) and other SUD, embedding tobacco treatment into structured SUD programs using an opt-out approach may yield a greater impact. The current study compares clinical outcomes (i.e., quit attempts and prescription of tobacco cessation medications) for an opt-out versus opt-in approach to tobacco treatment. Tobacco use information was collected prior to and after implementation of an opt-out, eight-session, tobacco group treatment intervention. Patient self-report and medical chart review were utilized to identify individuals who began a tobacco cessation medication during treatment as well as those who reported quitting tobacco, defined as sustained tobacco abstinence for at least seven days. The analysis includes a total of N = 332 Veterans who enrolled in the Intensive Outpatient Program (IOP). Those enrolled in the opt-out tobacco treatment group reported a significantly higher rate of quitting tobacco (24.57%) than those in the opt-in group (2.55%; p <.001). Likewise, the opt-out group was prescribed tobacco cessation medications at a significantly higher rate than the opt-in group (55.00% compared to 14.65%; p <.001). An opt-out treatment approach to TUD in SUD treatment settings produced improved outcomes, including significantly more patients engaged in TUD treatment and a higher overall rate of SUD treatment completion. Given the disproportionately high rate of tobacco use among those seeking treatment for SUD, enhanced tobacco cessation interventions could result in both improved tobacco as well as other substance use outcomes. The implementation of an opt-out tobacco treatment intervention embedded into SUD programming is supported by our findings of reduced tobacco use among patients.

Tobacco use Prevalence in the Military Health System: A Retrospective Study.

Tobacco use is prevalent and has traditionally been higher in the U.S. Military population than in the civilian population, but studies are limited. The goal of this study was to evaluate tobacco use and tobacco cessation counseling within the US Military health system (MHS). This was a retrospective study assessing tobacco use and cessation counseling rates within the MHS from July 2016 to March 2022. Data for military tobacco use were obtained from the Defense Health Agency (DHA) Dashboard. US civilian tobacco rates were obtained from the Center for Disease Control and Prevention (CDC). Patients 18+ currently enrolled in direct care in military treatment facilities (MTFs) who had at least one direct primary care or well care gynecology encounter during the measurement years. Current tobacco use is defined as the presence of one coded indicator which included ICD 10CM codes, MEDCIN (a system of standardized medical terminology) Terms, and Vitals. Tobacco use is defined as the use of any form of tobacco (cigarette, cigar, vaping, or smokeless). The prevalence of tobacco use per month was analyzed from July 2016 through March 2022. After searching specifically for procedure codes for tobacco cessation counseling, a month-to- month trend of the rate of tobacco cessation counseling was also established. Data from 1.8 million patients were analyzed. Overall tobacco use within the MHS (including military dependents and retirees) decreased 1.68% (29.94 to 28.26%) from 2016 to 2022. Rates decreased by 3.24% (29.94 to 26.70%) from July 2016 to March 2021 before increasing by 1.56% (26.70 to 28.26%) from March 2021 to March 2022. Tobacco cessation counseling declined by 17.4% (28.4 to 11%) from July 2016 to March 2022. In comparison to the civilian population, tobacco use was 15.0% higher in the MHS. Tobacco use remains common in the United States but is more prevalent in both active duty military and military retirees than civilians. Tobacco cessation counseling within the MHS steadily declined from 2016 to 2022. While there has been an overall reduction in rates of tobacco use in the military population over the last 5 years there was an increase over the last 2 years. Further research is needed to elucidate tobacco use, the effect of tobacco cessation counseling in the military, and the potential role of tobacco cessation medications in reducing tobacco use within the MHS.

Introduction to Tobacco Cessation and Motivational Interviewing: Evaluation of a Lecture and Case-Based Learning Activity for Medical Students.

Introduction Despite the fact that tobacco use continues to have significant public health impacts, most healthcare providers are notadequately trained to counsel patients on their tobacco use or to provide cessation resources. Although all healthcare providers have a role in providing tobacco cessation assistance, physicians and advanced practice providers are generally the only practitioners able to furnish tobacco cessation medications and bill insurance for their cessation services. Therefore, ensuring these practitioners are properly trained to offer tobacco cessation to their patients is critical to addressing this public health threat. In line with this goal, this study outlines the curriculum evaluation for an innovative student-facilitated tobacco cessation activity for medical students. Methods A lecture and case-based learning activity was created and piloted with a class of first-year medical students. The activity was facilitated by fourth-year medical students. Students took a pre-session survey to establish baseline experience and beliefs and a post-session survey to ascertain their confidence in applying what was covered in the session. Descriptive statistics were utilized to analyze the data. Results One hundred and twenty-eight students completed both surveys. Prior to the activity, students reported low levels of confidence in their ability to counsel patients and knowledge of cessation resources. Following the activity, more than 90% reported improvement in their ability to assess a patient's willingness to quit and counsel those ready to quit. Greater than 80% reported an improvement in their ability to counsel patients not ready to quit and to establish a quit plan. More than 90% of students reported that the session increased their self-efficacy in helping patients quit and that it was worth their time, with 96% committing to increasing their tobacco cessation efforts with their patients. Discussion Students valued the training and almost all reported that it increased their ability to help patients quit smoking. The use of student-facilitated case-based learning provided both an opportunity for students to practice cessation techniques and a low-stakes introduction to the OSCE format without the need for extensive faculty resources. Although this session was run with first-year medical students, the curriculum presented can be used for residents, nurses, and other healthcare professionals.

Adding Virtual Reality Mindful Exposure Therapy to a Cancer Center's Tobacco Treatment Offerings: Feasibility and Acceptability Single-Group Pilot Study.

Smoking contributes to 1 in 3 cancer deaths. At the Stanford Cancer Center, tobacco cessation medication management and counseling are provided as a covered benefit. Patients charted as using tobacco are contacted by a tobacco treatment specialist and offered cessation services. As a novel addition, this study examined the acceptability of a virtual reality (VR) mindful exposure therapy app for quitting smoking called MindCotine. The objective of this study was to determine the feasibility and acceptability of offering 6 weeks of MindCotine treatment as a part of Stanford's Tobacco Treatment Services for patients seen for cancer care. As part of a single-group pilot study, the MindCotine VR program was offered to English- or Spanish-speaking patients interested in quitting smoking. Given the visual interface, epilepsy was a medical exclusion. Viewed from a smartphone with an attachable VR headset, MindCotine provides a digital environment with audiovisual content guiding mindfulness exercises (eg, breathing techniques, body awareness, and thought recognition), text-based coaching, and cognitive behavioral therapy-based self-reflections for quitting smoking. Interested patients providing informed consent were mailed a MindCotine headset and asked to use the app for 10+ minutes a day. At the end of 6 weeks, participants completed a feedback survey. Of the 357 patients reached by the tobacco treatment specialist, 62 (17.3%) were ineligible, 190 (53.2%) were not interested in tobacco treatment services, and 78 (21.8%) preferred other tobacco treatment services. Among the 105 eligible and interested in assistance with quitting, 27 (25.7%) were interested in MindCotine, of whom 20 completed the informed consent, 9 used the program, and 8 completed their end-of-treatment survey. Participants using MindCotine completed, on average, 13 (SD 20.2) program activities, 19 (SD 26) journal records, and 11 (SD 12.3) coaching engagements. Of the 9 participants who used MindCotine, 4 (44%) reported some dizziness with app use that resolved and 7 (78%) would recommend MindCotine to a friend. In total, 2 participants quit tobacco (22.2% reporting, 10% overall), 2 others reduced their smoking by 50% or more, and 2 quit for 24 hours and then relapsed. In a feasibility and acceptability pilot study of a novel VR tobacco treatment app offered to patients at a cancer center, 4 of 9 (44%) reporting and 4 of 20 (20%) overall substantially reduced or quit using tobacco after 6 weeks and most would recommend the app to others. Further testing on a larger sample is warranted. ClinicalTrials.gov NCT05220254; https://clinicaltrials.gov/study/NCT05220254.

Abstract 12140: Clinical Care for Life’s Essential 8 by Medical Specialty in the United States

Background: The American Heart Association recognizes “Life’s Essential 8 (LE8)” as key to achieving cardiovascular health (CVH). Partnership between patients and clinicians will be vital to achieving LE8 and CVH, but one key question is which clinicians can influence their patients’ LE8. Here, we aimed to discover who provides clinical care for LE8 by clinician specialty. Method: We used all adult respondents from the nationally representative 2017-2019 Medical Expenditure Panel Survey. We classified visits to the specialties most relevant to LE8 care. Four LE8 measures represented what clinician type prescribed (1) statins, (2) diabetes mellitus medications, (3) anti-hypertensive medication, and (4) tobacco cessation medication (buproprion amongst tobacco users or varenicline). We assessed four other LE8 measures by which clinician saw a patient who reported: (1) low physical activity, defined as lack of moderate-vigorous physical activity 5 times per week, (2) obesity, (3) tobacco use, and (4) insomnia. We also evaluated report of a general check-up. We were unable to assess diet. We performed descriptive statistics with complex survey weights. The OhioHealth Institutional Review Board ruled the study exempt. Results: The study included 50,542 adults. Results, which are detailed in the table, found that for all measures, many people with gaps in LE8 saw neither a primary care doctor nor a cardiologist and between 2.5 and 5 times as many people with gaps in LE8 saw primary care without seeing a cardiologist than saw a cardiologist at all. Discussion: We found that primary care provides the large majority of medical care for all of LE8. Patients with gaps in LE8 who saw neither cardiology nor primary care were also common. Our findings emphasize how particular supporting primary care in their core functions of preventive care and chronic disease management will be key to achieving cardiovascular health.

Cost-Effectiveness of a Comprehensive Primary Care Smoking Treatment Program

Smoking is the leading preventable cause of death and disease in the U.S. This study evaluates the cost-effectiveness from a healthcare system perspective of a comprehensive primary care intervention to reduce smoking rates. This pragmatic trial implemented electronic health record prompts during primary care visits and employed certified tobacco cessation specialists to offer proactive outreach and smoking cessation treatment to patients who smoke. The data, analyzed in 2022, included 10,683 patients in the smoking registry from 2017 to 2020. Pre-post analyses compared intervention costs to treatment engagement, successful self-reported smoking cessation, and acute health care utilization (urgent care, emergency department visits, and inpatient hospitalization). Cost per quality-adjusted life year was determined by applying conversion factors obtained from the tobacco research literature to the cost per patient who quit smoking. Tobacco cessation outreach, medication, and counseling costs increased from $2.64 to $6.44 per patient per month, for a total post-implementation intervention cost of $500,216. Smoking cessation rates increased from 1.3% pre-implementation to 8.7% post-implementation, for an incremental effectiveness of 7.4%. The incremental cost-effectiveness ratio was $628 (95% CI: $568, $695) per person who quit smoking, and $905 (95% CI: $822, $1,001) per quality-adjusted life year gained. Acute health care costs decreased by an average of $42 (95% CI: -$59, $145) per patient per month for patients in the smoking registry. Implementation of a comprehensive and proactive smoking cessation outreach and treatment program for adult primary care patients who smoke meets typical cost-effectiveness thresholds for healthcare.

Implementation of evidence-based primary cancer prevention interventions in MA community health centers: an explanatory sequential mixed methods study

BackgroundMore than half of cancers could be prevented by employing evidence-based interventions (EBIs), including prevention interventions targeting nutrition, physical activity, and tobacco. Federally qualified health centers (FQHCs) are the primary source of patient care for over 30 million Americans — making them an optimal setting for ensuring evidence-based prevention that advances health equity. The aims of this study are to (1) determine the degree to which primary cancer prevention EBIs are being implemented within Massachusetts FQHCs and (2) describe how these EBIs are implemented internally and via community partnerships.MethodsWe used an explanatory sequential mixed methods design to assess the implementation of cancer prevention EBIs. First, we collected 34 quantitative surveys from staff at 16 FQHCs across Massachusetts to determine the frequency of EBI implementation. We followed up with 12 qualitative one-on-one interviews among a sample of staff to understand how the EBIs selected on the survey were implemented. Exploration of contextual influences on implementation and use of partnerships was guided by the Consolidated Framework for Implementation Research (CFIR). Quantitative data were summarized descriptively, and qualitative analyses used reflexive, thematic approaches, beginning deductively with codes from CFIR, then inductively coding additional categories.ResultsAll FQHCs indicated they offered clinic-based tobacco interventions, such as clinician-delivered screening practices and prescription of tobacco cessation medications. Quitline interventions and some diet/physical activity EBIs were available at all FQHCs, but staff perceptions of penetration were low. Only 38% of FQHCs offered group tobacco cessation counseling and 63% referred patients to mobile phone-based cessation interventions. We found multilevel factors influenced implementation across intervention types — including the complexity of intervention trainings, available time and staffing, motivation of clinicians, funding, and external policies and incentives. While partnerships were described as valuable, only one FQHC reported using clinical-community linkages for primary cancer prevention EBIs.ConclusionsAdoption of primary prevention EBIs in Massachusetts FQHCs is relatively high, but stable staffing and funding are required to successfully reach all eligible patients. FQHC staff are enthusiastic about the potential of community partnerships to foster improved implementation—providing training and support to build these relationships will be key to fulfilling that promise.

Patient awareness, perceptions, and attitudes towards pharmacists prescribing tobacco cessation medications

BackgroundRecent legislative advances now permit pharmacists to prescribe tobacco cessation medications in 17 states. While national initiatives are underway to prepare the pharmacy profession for this expanded role, patient perceptions of this role have not been explored. ObjectiveThe objective of this study was to characterize patient perceptions, attitudes, and awareness of pharmacists prescribing for tobacco cessation medications. MethodsA cross-sectional survey of English and Spanish-speaking patients was conducted at 12 locations of a federally-qualified health center in Northwest Indiana. Survey measures assessed sociodemographics, tobacco use history and interest in quitting, prior interactions with pharmacists and awareness of pharmacists’ ability to prescribe tobacco cessation medications, and perceptions of pharmacists assisting with cessation. The Theory of Planned Behavior (TPB) served as a framework for item development. Multivariable logistic regression was used for modeling. ResultsA total of 2082 individuals (1878 English, 204 Spanish) completed the survey (42.4%). Among current users (n = 592; 28.4%), 46.2% had made a quit attempt in the past year, and 41.0% reported having used a tobacco cessation medication in the past. Over half (60.5%) of current users would be comfortable talking with a pharmacist about quitting, 31.9% intended to talk with a pharmacist about quitting, and 31.7% intended to ask a pharmacist to prescribe a medicine to help with quitting. In multivariable modeling, intention to (a) talk with a pharmacist about quitting and (b) ask a pharmacist to prescribe a medication were significantly associated with TPB constructs. Current tobacco users were receptive to pharmacist-facilitated assistance with quitting, including prescribing of tobacco cessation medications. ConclusionsPatients’ attitudes, subjective norms, and perceived behavioral control, from the Theory of Planned Behavior, were important predictors of intention to engage with pharmacists for quitting and intention to ask a pharmacist to prescribe a cessation medication.

Tobacco Education in Doctor of Pharmacy Programs in the United States (2021-2022)

ObjectiveTo characterize (1) tobacco cessation content, delivery, and assessment methods, (2) faculty perceptions of content adequacy, and (3) faculty interest in enhancing curricular content as a result of pharmacists’ new, expanding role in prescribing tobacco cessation medications. MethodsOne faculty member responsible for teaching tobacco cessation-related content at each college and school of pharmacy was invited to participate in a national, web-based survey. Survey items assessed various aspects of tobacco education and gauged faculty interest in attending a train-the-trainer program and integrating Tobacco Treatment Specialist training as part of the curriculum at their institution. ResultsOf 132 survey respondents (93.0% response), 98.5% reported integrating tobacco cessation into the required curriculum, and 15.2% integrated the content into an elective course. The median number of formal educational hours was 5.0 (range, 1.0–18.0). One-third (33.3%) assessed students’ tobacco cessation competency using objective structured clinical examinations. Most (83.8%) felt that their institution has adequate faculty expertise to teach comprehensive tobacco cessation, and 98.5% were interested in attending a train-the-trainer program for pharmacy faculty to learn to educate students on the latest developments of pharmacist-provided tobacco cessation. Similarly, 95.4% were interested in incorporating Tobacco Treatment Specialist training into their Doctor of Pharmacy curriculum. ConclusionGiven the expanding scope of pharmacists’ practice for prescribing tobacco cessation medications, there is a need to enhance curricular content in Doctor of Pharmacy programs. Current faculty expressed interest in expanding coursework to enable their graduates to work at the top of their license when treating tobacco use and dependence.

How do patients and staff in an opioid agonist treatment service view smoking cessation medications and e-cigarettes?

Tobacco use and related mortality is common in people receiving opioid agonist treatment (OAT). Smoking cessation medications are available and e-cigarettes are increasingly recommended for high risk populations. This study explores experience, knowledge and attitudes around smoking cessation medications (nicotine replacement therapy [NRT], bupropion and varenicline) and e-cigarettes in patients and clinicians in two public Australian OAT clinics. Cross-sectional surveys of patients and clinicians and a randomly sampled retrospective medical record review. Patients were recruited through an advertisement in the clinic, and clinicians through advertisement at an educational session. Ninety-one patients and 10 clinicians completed the surveys. Most patients had at least one quit attempt and 43% were currently trying to quit. There were high levels of exposure to NRT, lower levels with varenicline and very limited exposure to bupropion. Patients considered e-cigarettes most helpful, but were more likely to consider using NRT. Few patients reported smoking cessation interventions from their clinicians. Most clinicians identified high tobacco use prevalence, considered this problematic, but reportedlow rates of smoking cessation intervention. NRT was the preferred medication. E-cigarettes were not considered helpful. Sixty-six percent of the 140 records reviewed documented patients as smokers. Tobacco cessation medication was rarely discussed or provided. Patients report high rates of tobacco cessation planning, but low rates of intervention. Experience of varenicline and bupropion is limited. E-cigarettes were preferred over varenicline and bupropion. Improving patient's and clinician's knowledge oftobacco cessation medications could improve smoking cessation interventions and uptake of approved medications.

Update and recommendations: Pharmacists’ prescriptive authority for tobacco cessation medications in the United States

To characterize state laws in the United States regarding the expansion of pharmacists’ prescriptive authority for tobacco cessation medications, compare key components across different models, and discuss important considerations for states that are considering similar legislation or policies.Legislative language was reviewed and summarized for all states with pharmacist prescriptive authority for tobacco cessation medications, and state boards of pharmacy were contacted to determine the number of registered complaints or safety concerns received as a result of pharmacists’ prescribing under these authorities.As of June 2022, 17 states have enacted laws for pharmacists’ prescriptive authority for tobacco cessation medications; most (N = 16) have implemented procedures, and 1 is in the process of adopting a similar prescribing model. Of 16 states with fully delineated protocols, 8 (Colorado, Idaho, Indiana, New Mexico, North Dakota, Oregon, Utah, Vermont) include all medications approved by the U.S. Food and Drug Administration for smoking cessation, and 8 (Arizona, Arkansas, California, Iowa, Maine, Minnesota, Missouri, North Carolina) include nicotine replacement therapy medications only. Most protocols specify minimum cessation education requirements for pharmacists and define required intervention elements (e.g., screening, cessation intervention components, follow-up, and documentation requirements). Personal communications with state boards of pharmacy revealed no complaints or safety concerns regarding pharmacists’ prescribing for cessation medications since these authorities were first implemented, in New Mexico, in 2004.The number of states with pharmacists’ prescriptive authority for tobacco cessation medications has increased substantially in recent years. There have been no registered complaints or safety concerns since the inception of this expanded scope of practice. Although the profession has made meaningful progress, there are inconsistencies across states with respect to medications that are included and requirements for implementing tobacco cessation services, which may impede broader adoption.

Smoking-Cessation Assistance Among Older Adults by Ethnicity/Language Preference

Although smoking prevalence is lower among Hispanic adults than among non-Hispanic White adults, smoking remains a leading cause of preventable death among older Hispanics. This study examines the differences in tobacco assessment and smoking-cessation assistance among older patients seen in community health centers by ethnicity and language preference. Electronic health record data were extracted from the Accelerating Data Value Across a National Community Health Center Network of community health centers from patients aged 55‒80 years with ≥1 primary care visit between January 1, 2017 and December 31, 2018. Binary outcomes included tobacco use assessment and, among those with ≥1 status indicating current smoking, having a smoking-cessation medication ordered. The independent variable combined ethnicity and language preference, categorized as non-Hispanic White (reference), Spanish-preferring Hispanic, and English-preferring Hispanic. Multivariable generalized estimating equation logistic regressions, clustering by primary care clinic using an exchangeable working correlation structure, modeled the odds of tobacco use assessment and cessation medication orders by ethnicity/preferred language, adjusting for patient covariates, health system, and clinic location. Analyses were conducted in 2021. The study included 116,328 patients. Spanish-preferring Hispanic patients had significantly lower odds of having tobacco use assessed than non-Hispanic White patients (AOR=0.89, 95% CI=0.82, 0.95). Both Spanish- and English-preferring Hispanic patients had lower odds of having a smoking-cessation medication ordered (AOR=0.53, 95% CI=0.47, 0.60; AOR=0.77, 95% CI=0.67, 0.89, respectively) than non-Hispanic White patients. Significant disparities were found in tobacco assessment and cessation assistance by ethnicity and language preference among older adults seen in safety-net clinics. Future research is needed to understand the etiology of these smoking-related disparities.

Relationship Between Reception of Low-Dose Computed Tomography Screening, Tobacco Cessation Attempt, and Reception of Pneumococcal Vaccine.

The stage at diagnosis is the single most important predictor of lung cancer outcome. Therefore, detecting lung cancer early is of utmost importance. Low-dose computed tomography (LDCT) has proven beneficial in the early detection and mortality reduction of lung cancer. Despite this, very few of the high-risk population get annual LDCT done. Patients' attitudes towards tobacco usage and preventive care can be a factor in getting LDCT. We analyzed the relationship between the willingness to undergo LDCT and a person's readiness to try tobacco cessation medication or get the pneumococcal vaccine. We also analyzed the relationship between patients who had tobacco cessation counseling and their willingness to get LDCT and pneumococcal vaccine. Medical records of high-risk patients seen in the East Tennessee State University (ETSU) clinics between January 1, 2016, and November 30, 2020, were analyzed retrospectively. In the data obtained, a total of 2,834 patients were current smokers and were included in the research. The study subjects were assessed in two ways, which from here on will be referred to as method one and method two. In the first method, patients who underwent LDCT were assessed, and the outcome investigated was tobacco cessation counseling, tobacco cessation medication prescription, and pneumococcal vaccination. In the second method, patients who had tobacco cessation counseling were assessed, and the outcome evaluated was LDCT, tobacco cessation medication prescription, and pneumococcal vaccination. In the first method, out of 2,834 total population, 570 had undergone at least one LDCT screening during the study period. Of the 570 patients who underwent LDCT, 22.8% tried one of the tobacco cessation medications at least once during the study period (vs. 9.8% in patients who did not get the LDCT). Also, 71.5% of patients who had LDCT received at least one dose of pneumonia vaccine (vs. 35.5% in patients who did not get the LDCT). In the second method, 1,673 out of 2,834 patients received at least one tobacco cessation counseling, and out of those, 27.5% had LDCT screening (vs. 9.5% among those who never received counseling). Also, 54.9% received a pneumococcal vaccine (vs. 45.1% among those who did not receive counseling). The study demonstrates a relationship between getting LDCT and getting a pneumococcal vaccine or tobacco cessation medications. It also reveals that tobacco cessation counseling increases the odds of getting LDCT, tobacco cessation medications, and pneumococcal vaccine.

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.

Integration of a Tobacco Treatment Specialist into Primary Care: Perception from Multidisciplinary Team

Background Tobacco continues to be on the leading cause of avoidable death. Primary care practices are ideal locations to provide tobacco cessation visits. Tobacco treatment specialists are trained individuals with expertise in providing medication and counseling management to patients to help with tobacco cessation. Purpose The purpose of this study was to examine the integration of a tobacco treatment specialist into the primary care setting and the perception of this role from the multidisciplinary team. Method We conducted an electronic cross-sectional survey to evaluate awareness and perception of the integration of a tobacco treatment specialist into a primary care facility that is part of a large Midwestern tertiary healthcare center. The sample for this study included all the primary clinic staff that directly work with patients and included licensed practical nurses, registered nurses, physician assistants, certified nurse practitioners, and medical doctors. Results 55% (n = 22) of staff had utilized the tobacco treatment specialist with direct patient care. Reasons for using the specialist was for referral for follow-up tobacco cessation visit (54%), curbside consultations (21%), medication management (21%), and other reasons (5%). The majority of staff strongly agreed that utilizing the TTS was valuable. Conclusion This study reinforced the positive impact a tobacco treatment specialist can have being integrated into the primary care practice from the perception of the multidisciplinary team.

Tobacco cessation services and medications to quit tobacco for NCD patients

Tobacco cessation services and medications to quit tobacco for NCD patients

The current state of tobacco cessation treatment.

Nicotine addiction and dependence is a chronic relapsing disease driven by addiction to nicotine. Proactive treatment for all tobacco users, regardless of their readiness to quit, is recommended. First-line tobacco cessation medications include nicotine replacement therapy, bupropion, and varenicline. Comprehensive treatment with behavioral interventions and pharmacologic therapy increases success rates of smoking cessation. Although there are many popular alternative treatments, they should not replace or delay the use of known effective therapies.

A cluster randomized trial evaluating a teachable moment communication process for tobacco cessation support

IntroductionThis study examines the uptake of a clinician-focused teachable moment communication process (TMCP) and its impact on patient receipt of tobacco cessation support. The TMCP is a counseling method that uses patient concerns to help clinicians guide behavior change discussions about tobacco. We evaluate the added value of the TMCP training in a health system that implemented an Ask-Advise-Connect (AAC) systems-based approach.MethodsA stepped wedge cluster randomized trial included eight community health centers. Training involved a web module and onsite skill development with standardized patients and coaching. Main outcome measures included contact and enrollment in cessation services among patients referred for counseling, prescription of cessation medications and quit attempts.ResultsForty-four of 60 eligible clinicians received the TMCP training. Among TMCP-trained clinicians 68% used a TMCP approach (documented by flowsheet use) one or more times, with the median number of uses being 15 (IQR 2–33). Overall, the TMCP was used in 661 out of 8198 visits by smokers (8%). There was no improvement in any of the tobacco cessation assistance outcomes for the AAC + TMCP vs. the AAC only period. Visits where clinicians used the TMCP approach were associated with increased ordering of tobacco cessation medications, (OR = 2.6; 95% CI = 1.9, 3.5) and providing advice to quit OR 3.2 (95% CI 2.2, 4.7).ConclusionsDespite high fidelity to the training, uptake of the TMCP approach in routine practice was poor, making it difficult to evaluate the impact on patient outcomes. When the TMCP approach was used, ordering tobacco cessation medications increased.ImplicationsTobacco cessation strategies in primary care have the potential to reach a large portion of the population and deliver advice tailored to the patient. The poor uptake of the approach despite high training fidelity suggests that additional implementation support strategies, are needed to increase sustainable adoption of the TMCP approach.Trial Registrationclinicaltrials.gov #NCT02764385, registration date 06/05/2016.

Perspectives and perceived barriers to pharmacist-prescribed tobacco cessation services in the community pharmacy setting

Objective(s)Tobacco use is a leading cause of preventable morbidity and mortality in the United States. Community pharmacists are in an advantageous position to increase patient accessibility to tobacco cessation medications and counseling. Pharmacists are permitted to prescribe or furnish tobacco cessation medications in 13 states with varying requirements and limitations. The primary objective of this study was to evaluate the perspectives and perceived barriers that pharmacy personnel have in providing pharmacist-prescribed tobacco cessation services in the community pharmacy setting. The secondary objectives were to evaluate current practices of the 5 A’s model and to identify additional training needed to provide the service. MethodsThis study was a descriptive cross-sectional electronic survey of pharmacy personnel from a large grocery pharmacy chain. The respondents were asked about their demographics, current practices of the 5 A’s model, perceived barriers and attitudes toward pharmacist-prescribed tobacco cessation services, and additional training needed to provide the service. ResultsThe survey received 79 responses from pharmacists. The results showed that 92.4% (73/79) of the respondents agreed that community pharmacists should provide tobacco cessation services. The biggest barrier identified was “lack of time during normal workflow to deliver tobacco cessation services” at 54.4% (43/79). Regarding the 5 A’s model, 74.7% (59/79) of the pharmacists responded “never” or “somewhat infrequently” to how often they practice the “Ask” step, with other steps in the 5 A’s model reported at similar frequencies. The top 3 additional trainings that the pharmacists identified were “strategies developing a follow-up plan with patients,” “incorporating service into workflow,” and “strategies providing counseling on tobacco cessation.” ConclusionEfforts should be made to give community pharmacy personnel more time and guidance to provide patient care services beyond traditional dispensing roles to provide tobacco cessation services.

New resource explores ways pharmacists lead smoking cessation efforts

Medical Arts Pharmacy in Fayetteville, AR, is the only local provider in the area offering smoking cessation counseling and support to patients. “There are a lot of people who need this service and doctors just don't have time to go through all the things we go through to help people be successful,” said Julie Stewart, PharmD, who has been practicing at the pharmacy for over 15 years. Word is out that pharmacists are in a perfect position to help patients quit tobacco. In January of this year, the Surgeon General released the first report on smoking cessation in 30 years, highlighting the important role pharmacists play in cessation efforts. “All pharmacists, along with other members of the health care team, play a critical role in screening patients for tobacco product use and in providing treatment options and supportive care to help patients quit,” said RADM Ty Bingham, PharmD, chief pharmacy officer with the U.S. Public Health Service. “We can improve access to evidence-based cessation services for individuals seeking to quit.” Evidence has shown that quit attempts are most successful when supported by evidence-based treatments, including pharmaceutical aids and counseling services, and the profession of pharmacy has made major strides to have a prominent role in tobacco cessation efforts over the decades. A new resource from APhA (www.pharmacist.com/tobaccocessation/promising-practices) was developed to highlight the ways in which pharmacists are engaging with tobacco cessation interventions. “These case studies showcase how pharmacists in different health care settings across the nation are maximizing their expertise to assist patients who use tobacco to quit, setting them on course for improved health and well-being,” RADM Bingham said. Across the United States, the pharmacy practice landscape varies for a number of reasons, including state pharmacy acts, patient populations, practice settings, payer relationships, and more. When the smoking cessation program started at Medical Arts Pharmacy in 2019, services were supported by grant funding that lasted for a 4-month period. Today, even without the financial support, pharmacists at Medical Arts still provide the service to patients at no cost. “We wanted to continue with the momentum we had from the program mostly in hopes of building our reputation and confidence in our process so we would have a good program in place when reimbursement does come,” said Stewart. Pharmacists are not recognized on the federal level or on the state level in Arkansas as health care providers who can bill and be reimbursed for services. Pharmacists at Medical Arts are compensated through the sale of tobacco cessation medications only—they are reimbursed for the cost of the medication and provided a nominal dispensing fee. Patients may also pay cash for the nicotine replacement therapies (NRTs) if their insurance does not cover them. For patients without insurance, the pharmacist collaborates with the Arkansas Department of Health, which provides NRTs at no cost to patients. However, the pharmacy does not receive a dispensing fee for the service. Pharmacists like Alexa Valentino who work on a health care team have an easier time with reimbursement for smoking cessation services. Valentino works at PrimaryOne Health, a federally qualified health center (FQHC) in the Columbus, OH, area. She came on board in 2013, a year after tobacco cessation had been established as a core patient care service provided by pharmacists at the FQHC. Pharmacists at PrimaryOne Health have expanded their ability to bill for tobacco cessation counseling services, primarily through payers, and have subsequently increased authority through a collaborative practice agreement for the management of tobacco use disorder. Typically, patients are referred to the pharmacist-provided tobacco cessation program by other practitioners in the center. “Our providers love that we provide this service and it was a great place to start to build relationships with providers and to build their trust in what we can do as pharmacists,” said Valentino, PharmD, BCACP, lead clinical pharmacist at PrimaryOne Health. Over the years, pharmacists there have been able to expand beyond smoking cessation to manage other disease states as additional needs were identified and new billing opportunities presented themselves to Ohio pharmacists. But Valentino said offering smoking cessation services to patients is a great place for pharmacists anywhere to start providing patient care services because other health care providers are eager for pharmacists to take it on.