A38-14 Persistent Tobacco Use: Trends and Clinical Implications

Abstract Introduction Treating nicotine dependence remains a challenging task for both provider and patient. Many patients cite it as harder than treating alcohol or opioid dependence. Here we explore trends among patients who have struggled to make progress. Methods An Epic Reporting Workbench report was created to view the results of 499 patients’ flowsheets outlining their tobacco use status at last encounter, medication plan, and medication compliance. The report also included demographic data such as race, zip code, and insurance. This report was compared to a BI Launchpad report of mental health conditions (MHCs) in this patient population. All patients were seen by a pulmonologist or pulmonary nurse practitioner and Certified Tobacco Treatment Specialist (CTTS) in a tobacco treatment clinic. At their first appointment, patients were prescribed 1-2 controllers (varenicline, bupropion, nicotine patch) and 1 rescue (nicotine gum, lozenge, inhaler, nasal spray). Medication instructions were reviewed and all patients were encouraged to stay in touch with the CTTS for ongoing support including help with obtaining medications and managing side effects. A follow-up appointment is scheduled at check-out.Results164/499 patients either had not reduced/stopped their tobacco use, had increased their tobacco use, or had relapsed after stopping. In the general population reviewed for a previous abstract, 69.1% of patients had been diagnosed with at least 1 MHC. Among the 164 patients reviewed here, 112 (68.2%) had been diagnosed with at least 1 MHC. 64/112 (58.0%) had a history of substance use disorder (SUD). 20/164 (12.2%) have HIV. 125/164 (76.2%) are Black. 136/164 (82.9%) are on Medicare/Medicaid. 92/164 (56.1%) had no change in tobacco use, 34/164 (20.7%) increased their tobacco use, and 38/164 (23.2%) relapsed. Just 8/164 (4.9%) were fully compliant with their medications. 89/165 (54.3%) were not using any medications. The remaining 67/164 (40.9%) were partially compliant (taking just 1 medication, did not take medication every day, etc.) (see Figure 1). Inadequate access to medication and overall treatment is common throughout the clinic population. Patients cited lack of medication coverage, prior authorizations, unreliable transportation, and misinformation about tobacco and treatment as barriers to care. Discussion These results reinforce the value of medication access and compliance. While MHCs and SUD are prominent in this population, they do not appear to be a defining factor in tobacco treatment outcomes. The cost of dual pharmacotherapy is staggeringly cheap for insurance companies, especially when compared to the cost burden of managing chronic conditions. This abstract is funded by: None