Prevalence and trends of missed opportunities for tobacco use screening and assistance with tobacco cessation during outpatient care

Introduction: U. S. Public Health Service Guidelines recommend that clinicians and health care delivery systems identify and treat every tobacco user. We assessed the prevalence, characteristics, and trends in missed opportunities for tobacco use screening and cessation assistance (counseling and/or medication) during U.S. outpatient visits from 2005 to 2010.

Methods: Data came from the 2005-2010 National Ambulatory Medical Care Survey, a survey of U.S. outpatient visits made to office-based physicians, and the National Hospital Ambulatory Medical Care Survey, a sample of U.S. visits to emergency and outpatient departments. The combined sample included 290,914 visits among adults aged ≥18 years. Screening was defined as documentation of current tobacco use status on the Patient chart. Cessation assistance was defined as documentation of tobacco counseling and/or cessation medications. Logistic regression was used to assess trends during 2005–2010.

Results: During 2005–2010, tobacco screening did not occur during 33.5% (277 million) outpatient visits annually. Among patients who screened positive for current tobacco use, 76.9% were not provided cessation assistance. During 2005–2010, no significant change occurred in the lack of screening or cessation assistance. Lack of screening was greater among Hispanics and those who didn’t visit a primary care provider. Lack of cessation assistance was greater among those aged 18-24 and 25-44 years, who didn’t visit a primary care provider, and whose visit wasn’t primarily for preventive care.

Conclusions: Key opportunities exist to increase tobacco screening and cessation assistance in clinical settings, including adopting tobacco cessation treatment for adults as a covered health benefit.