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35th AM (2025) - Poster Session
Implementing a Tobacco-treatment Medication Workfl ...
Implementing a Tobacco-treatment Medication Workflow in FQHCs
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This retrospective study evaluated the impact of enhanced electronic health record (EHR) tobacco order set workflows on tobacco pharmacotherapy prescribing and behavioral treatment referrals among patients with mental health (MH) diagnoses at eight large Federally Qualified Health Center San Diego (FHCSD) clinics. Data from July 2022 to February 2023, including 4 months before and 2 months after implementation, were analyzed. The patient cohort primarily included individuals with depression, anxiety, bipolar disorder, psychotic disorders, and notably PTSD (n=10,613), among whom 21% reported tobacco use.<br /><br />Demographically, MH diagnoses were more prevalent in middle-aged adults, females, and White or Hispanic patients. Homelessness and higher tobacco and substance use rates were more common in patients with psychotic and bipolar disorders. Following the EHR workflow enhancement, tobacco treatment medication prescribing increased significantly by 34.5% overall (p<0.01), indicating improved care engagement.<br /><br />Importantly, patients with PTSD exhibited a stronger increase in tobacco medication orders compared to other MH groups (p=0.04). Behavioral tobacco treatment referrals also rose (p=0.02), although no significant difference was observed between PTSD and non-PTSD groups for behavioral engagement (p=0.41). Specific medications such as the nicotine patch, nicotine replacement therapy, and varenicline all showed significant increases post-implementation (p<0.01), with a trend toward differential effects by PTSD diagnosis (p=0.06).<br /><br />The study highlights the disproportionate tobacco use burden among low-income populations with MH conditions and the historically low treatment engagement in FQHC settings despite universal screening. Implementing targeted, tailored EHR order sets effectively increased tobacco treatment uptake, particularly benefiting PTSD patients. The findings suggest that certain subpopulations may respond more positively to systemic workflow interventions. Future research should explore the mechanisms behind these differential effects, examine provider and clinic workflow influences, and assess the sustainability and scalability of such interventions to optimize tobacco cessation efforts in vulnerable MH populations.
Keywords
electronic health record
tobacco pharmacotherapy
behavioral treatment referrals
mental health diagnoses
Federally Qualified Health Centers
PTSD
tobacco use
workflow enhancement
nicotine replacement therapy
tobacco cessation
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