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Rheumatologists Modestly More Likely to Counsel Smokers in Visits Without Rheumatoid Arthritis Control

An Observational Study

Vreede, Andrew P. MD*; Johnson, Heather M. MD, MS*†; Piper, Megan PhD*‡; Panyard, Daniel J. BS; Wong, Joanna C. MD; Bartels, Christie M. MD, MS

JCR: Journal of Clinical Rheumatology: August 2017 - Volume 23 - Issue 5 - p 273–277
doi: 10.1097/RHU.0000000000000559
Original Articles
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Background Among patients with rheumatoid arthritis (RA), smoking increases risk of severe RA and pulmonary and cardiovascular disease. Despite this, little is known about smoking cessation counseling by rheumatologists.

Objectives We examined predictors of tobacco counseling in RA patients who smoke including the effect of perceived RA control. We hypothesized that patients with controlled RA would receive more counseling according to the competing demands model, which explains that preventive care gaps occur as a result of competing provider, patient, and clinic factors.

Methods This secondary data analysis involved RA patients with an additional cardiovascular disease risk factor identified in an academic medical center 2004–2011. Trained abstractors assessed documented smoking counseling and rheumatologists’ impression of RA control in clinic notes. We used multivariable logistic regression to predict having received smoking cessation counseling, including sociodemographics and comorbidity in models.

Results We abstracted 3396 RA visits, including 360 visits (10%) with active smokers. Perceived controlled RA was present in 31% of visits involving smokers (39% in nonsmokers). Beyond nurse documentation, providers documented smoking status in 39% of visit notes with smokers and smoking cessation counseling in 10%. Visits with controlled versus active RA were less likely to include counseling (odds ratio, 0.3; confidence interval, 0.1–0.97). Counseling was more likely in visits with prevalent cardiovascular, pulmonary, and psychiatric disease, but decreased with obesity.

Conclusions Smoking cessation counseling was documented in 10% of visits and was less likely when RA was controlled. Given smoking’s impact on RA and long-term outcomes, systematic cessation counseling efforts are needed.

From the *Department of Medicine, †Division of Cardiovascular Medicine, ‡Center for Tobacco Research and Intervention, and §Division of Rheumatology, University of Wisconsin School of Medicine & Public Health, Madison, WI; and ‖Tufts University School of Medicine, Boston, MA.

This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health (NIH), under award K23AR062381 to C.M.B. Additional support was from NIH-NCATS 9U54TR000021 to the Health Innovation Program/Community-Academic Partnerships core of UW ICTR-CTSA, and NIH-NHLBI 1 K23 HL112907 to H.M.J. C.M.B. receives separate grant support from Independent Grants for Learning and Change (Pfizer), who had no role in the design, conduct, interpretation, or writing of the study manuscript.

The authors declare no conflict of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Correspondence: Christie M. Bartels, MD, MS, 1685 Highland Ave, Room 4132, Madison, WI 53705. E-mail: cb4@medicine.wisc.edu.

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