Documentation of tobacco use and assistance with tobacco cessation during ambulatory care visits: Findings from the 2005-2008 national ambulatory medical care survey (NAMCS)

Introduction: Tobacco use is a leading cause of preventable disease and death in the United States. The Public Health Services Guideline recommends that healthcare providers assess tobacco use and assist patients in quitting. The purpose of this study is to identify the proportion of outpatient visits with documented tobacco use, as well as referrals for tobacco cessation.

Methods: Data from the 2005-2008 National Ambulatory Medical Care Survey (NAMCS) were utilized to estimate the proportion of office-based physician visits with documented tobacco use. The NAMCS is a national probability sample survey of outpatient visits made to office-based physicians and measures health care utilization across health care providers. The sample included 99,275 outpatient visits among persons aged 15+ years. SUDAAN 10.0.1 was used to conduct the analysis.

Results: From 2005-2008, approximately 3.2 billion outpatient visits among aged 15+ years were made to office-based physicians, of which approximately 344 million were made by current tobacco users. Overall, 37.2% of patient visits did not include any information on tobacco use (2005: 33.1%; 2006: 38.2%; 2007: 41.2%; 2008: 36.4%). Further results on tobacco use and providing assistance with cessation will be presented as they varied with other co-variates (e.g., presence of chronic conditions, insurance type, time spent with physician, etc.).

Conclusions: Preliminary findings suggest that increases are needed in physicians' and health care providers' asking about and documenting tobacco use and assisting patients with tobacco cessation counseling and referrals. Key opportunities for progress include having tobacco cessation as a covered benefit and electronic health records.