Recent cessation attempts and receipt of cessation services among a diverse primary care population - A mixed methods study.

Introduction:
This article presents a mixed-methods study examining receipt of smoking cessation counseling and recent cessation attempts among primary care patients in four safety-net clinics in San Francisco. The researchers used the electronic health record (EHR) to examine receipt of cessation services and estimate cessation attempts, defined as a transition from current to former smoking status during the 9-month study period. They also conducted interviews with staff and patients to assess barriers to and facilitators of providing cessation services.

Key Points:

* The study found that the majority of patients (95.6%) received some type of cessation counseling during at least one clinical encounter, and 17.6% made a recent cessation attempt.
* Recent smoking cessation attempts and receipt of smoking cessation services differed significantly by clinic after adjusting for demographic factors.
* The study identified patient and staff-level predisposing, reinforcing, and enabling factors to increase delivery of cessation care, including increasing access to cessation medications and higher intensity counseling using a team-based approach.
* The EHR was found to be a useful tool to monitor patients' recent cessation attempts and access to cessation care.
* The study combined EHR data with qualitative methods to guide and streamline interventions to improve quality of cessation care and promote quit attempts among patients in safety-net settings.

Main Message:
The study highlights the importance of addressing smoking cessation in safety-net clinics, where smoking rates are high among low-income populations. The use of the EHR to monitor patients' recent cessation attempts and access to cessation services can help identify gaps in care and inform interventions to improve quality of care. The study also emphasizes the importance of addressing barriers to cessation care, including increasing access to cessation medications and higher intensity counseling using a team-based approach. By combining EHR data with qualitative methods, interventions can be tailored to the specific needs and barriers of patients and staff in safety-net settings.

Gubner NR, Williams DD, Chen E, et al. Recent cessation attempts and receipt of cessation services among a diverse primary care population - A mixed methods study. Preventive medicine reports. 2019;15:100907. doi:10.1016/j.pmedr.2019.100907