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Smoking Assessment by Visit Modality Among Community-based Primary Care Clinics.

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The COVID-19 public health emergency led to lower smoking assessment rates during telehealth visits compared to in-person visits. This disparity persisted, highlighting the need for improved tobacco treatment during virtual care.

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Area of Science:

  • Public Health
  • Health Services Research
  • Tobacco Control

Background:

  • The COVID-19 public health emergency disrupted primary care delivery, including tobacco treatment, causing disparities in cessation care.
  • Telehealth visits initially showed lower rates of smoking assessment compared to in-person visits during the pandemic.
  • The persistence of these disparities in smoking assessment during telehealth remains unclear.

Purpose of the Study:

  • To examine trends in smoking assessment rates during primary care visits before and after the COVID-19 public health emergency declaration.
  • To compare smoking assessment rates between in-person and telehealth visit modalities.
  • To identify disparities in tobacco treatment delivery during the public health emergency.

Main Methods:

  • Analysis of electronic health record data from over 1.7 million adult patients across 541 primary care clinics in 17 states between January 2019 and May 2023.
  • Examination of monthly percentages of visits including smoking assessment (yes/no) overall and by visit modality (in-person vs. telehealth).
  • Comparison of assessment rates before the public health emergency declaration (pre-March 2020) and during the subsequent period.

Main Results:

  • Telehealth visits increased significantly from <1% pre-pandemic to over 50% in the early pandemic, stabilizing at 25% later.
  • Overall smoking assessment rates dropped from >95% pre-pandemic to a maximum of 77% post-declaration.
  • In-person visit assessments decreased from >95% to a range of 46%-95%, while telehealth assessments peaked at only 9% in late 2022.

Conclusions:

  • Smoking assessment rates remained significantly lower during the public health emergency compared to pre-pandemic levels.
  • The primary driver of this reduction was the consistently low rate of smoking assessment during telehealth visits.
  • Enhanced strategies are crucial to ensure equitable smoking assessment and evidence-based tobacco treatment delivery via telehealth.