Who are we missing with EHR-Based Smoking Cessation Treatments? A Descriptive Study of Patients who Smoke and Do Not Regularly Visit Primary Care Clinics.

Introduction: Most tobacco treatment efforts target healthcare settings, since about 75% of smokers in the United States visit a primary care provider annually. Yet, 25% of patients may be missed by such targeting. Aims: To describe patients who smoke but infrequently visit primary care -- their characteristics, rates of successful telephone contact, and acceptance of tobacco treatment. Methods: Tobacco Cessation Outreach Specialists (TCOS) "cold-called" those without a primary care visit in the past year, offering tobacco dependence treatment. Age, sex, insurance status, race, ethnicity, EHR patient-portal status and outreach outcomes were reported. Results: Of 3,407 patients identified as smokers in a health system registry, 565 (16.6%) had not seen any primary care provider in the past year. Among 271 of those called, 143 (53%) were successfully reached and 33 (23%) set a quit date. Those without visits tended to be younger, male, some-day versus every-day smokers (42 vs. 44 yrs., p = 0.004; 48% vs. 40% female, p=0.0002, and 21% vs. 27% some-day, p=0.003), and less active on the EHR patient portal (33% vs. 40%, p =0.001). Conclusions: A substantial proportion of patients who smoke are missed by traditional tobacco treatment interventions that require a primary care visit, yet many are receptive to quit smoking treatment offers.