University of Wisconsin–Madison Medical College of Wisconsin

Missing Out: Underutilization of Primary Care by Wisconsin Patients Who Smoke and Its Implications for Tobacco Treatment Access

Margaret Nolan, MD, MS; Alexandra Spicer, BA; Patrick Remington, MD, MPH; Kristen Malecki, PhD, MPH; Danielle McCarthy, PhD

WMJ. 2022;121(4):263-268

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Introduction: Tobacco dependence treatment is usually offered in primary care settings. Yet, if many patients who smoke do no not access primary care, cessation interventions may be missing those who most need them. This study describes Wisconsin adults’ health care utilization by smoking status.

Methods: Data were analyzed from 1726 individuals participating in a population-based, cross-sectional, in-person health survey of Wisconsin residents (2014-2016). Demographic characteristics were compared across smoking status using Wald chi-square tests weighted for the complex survey design. Odds ratios were calculated using multivariate logistic regression models.

Results: Of 1726 respondents, 15.3% reported current smoking, 25.4% former smoking, and 59.4% never smoking. Those currently smoking were more likely than former- or never-smoking respondents to report emergency departments as their “usual place to go when sick” (12% vs 3%) or report they had “no place to go when sick” (16% vs 7%). People who currently smoke also reported more emergency department visits during the past year (mean = 1.4 visits) than did others (mean = 0.4, P < 0.01). Among those currently smoking, 18% reported that they “needed health care but didn’t get it” over the past year, compared to 6% of others (P < 0.01). Those currently smoking also were more likely to report a “delay in getting care” (16% vs 9%, P = 0.02) and were less likely to have had a “general health checkup” within the past year (58% vs 70%, P < 0.02). These relationships persisted in logistic regression models controlling for variables related to smoking status and health care utilization, including health insurance.

Conclusions: These findings suggest that more than a quarter of Wisconsin adults who smoke do not receive primary care every year and that they delay care or seek care in emergency departments more frequently than do those who never smoked or who quit smoking. As a result, such individuals may be missing out on evidence-based tobacco cessation treatment.

Author Affiliations: Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health (UWSMPH), Madison, Wisconsin (Nolan, McCarthy); Division of Pulmonary Medicine, UWSMPH, Madison, Wis (Spicer); Department of Population Health Sciences, UWSMPH, Madison, Wis (Remington, Malecki).
Corresponding Author: Margaret Nolan, MD, MS, UW Center for Tobacco Research and Intervention, 1930 Monroe St, #200, Madison, WI 53711; phone 608.262.8673; email; ORCID ID 0000-0001-5214-3992
Acknowledgements: The authors would like to thank Parvathy Pillai, MD, MPH, for her review of the data and abstract, and Michael Fiore, MD, for his review and comments on this manuscript. Kristen Malecki, MD, is the Principal Investigator for the Survey of the Health of Wisconsin grant.
Funding/Support:The data source, the Survey of the Health of Wisconsin, is funded by the Wisconsin Partnership Program PERC Award (233 PRJ 25DJ).
Financial Disclosures: None declared.
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