University of Wisconsin–Madison Medical College of Wisconsin

Identifying Differences in Rates of Invitation to Participate in Tobacco Treatment in Primary Care

Kristin M. Berg, MD, MS; Stevens S. Smith, PhD; Megan E. Piper, PhD; Michael C. Fiore, MD, MPH, MBA; Douglas E. Jorenby, PhD

WMJ. 2018;117(3):111-115.

Download full text pdf.


Introduction: The progress achieved in reducing tobacco use has not been consistent across groups of smokers, and health systems are inconsistently implementing best practice guidelines. Guideline implementation could be associated with improved treatment invitation rates.

Aims: To evaluate differences in tobacco treatment invitation rates based on patient characteristics in primary care clinics implementing best practice guidelines.

Methods: A secondary analysis of patients presenting to 11 primary care clinics from 2 Wisconsin health systems from June 2010 to February 2013. The main outcome was whether patients received an invitation to participate in tobacco treatment. Invitation rates were examined by sex, age group (≤ 24 years, 25-44, 45-64, ≥ 64), race (white, black, other), insurance status (private, Medicare, Medicaid, none), and visit diagnosis (“high-risk” [cardiovascular and pulmonary disease, malignancy, pregnancy] vs “low-risk” [all other ICD-9 categories]). Moderation effects of health systems also were examined.

Results: Of the 95,471 patients seen, 84,668 (89%) were screened for smoking. Among the 15,193 smokers, 10,242 (67%) were invited to participate. Invited patients were older, white or black, and carried low-risk diagnoses. Invitation rates and patient-level differences varied between the health systems.

Conclusions: Variable treatment invitation rates and health system differences remain evident in the primary care setting employing robust clinical practice guideline recommendations.

Author Affiliations: Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health (UWSMPH), Madison, Wis (Berg); Center for Tobacco Research and Intervention, UWSMPH, Madison, Wis (Berg, Smith, Piper, Fiore, Jorenby); Primary Care Research Fellowship, Department of Family Medicine and Community Health, UWSMPH, Madison, Wis (Berg).
Corresponding Author: Kristin M. Berg, MD, MS, Division of General Internal Medicine Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St, Suite 200, Madison, WI 53711; phone 608.262.7567; fax 608.265.3102; email
Previous Presentations: An earlier version of this work was presented as a poster at the Society of General Internal Medicine 2016 Annual Meeting in Hollywood, Florida (May 11-14, 2016), and the Society for Research on Nicotine and Tobacco 2016 Annual Meeting in Chicago, Illinois (March 2-5, 2016).
Funding/Support: This study was supported in part by a National Research Service Award from the Health Resources and Services Administration [T32HP10010] to the University of Wisconsin Department of Family Medicine and Community Health (Berg). UW-PASS was supported by grant 9P50CA143188 from the National Cancer Institute to the University of Wisconsin Center for Tobacco Research and Intervention. The funding sources did not have any role in study design, data collection, analysis, or interpretation or in the writing of this report.
Financial Disclosures: Dr Piper, Dr Fiore, and Dr Jorenby received a grant from the National Cancer Institute.
Share WMJ