Clinicians Frequently Miss Opportunities to Address Secondhand Smoke Exposure

NEJM – Jorunal Watch

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Clinicians rarely counsel hospitalized cardiac patients about secondhand smoke exposure, according to a research letter in JAMA Internal Medicine.

Some 200 nonsmoking inpatients with coronary heart disease were interviewed about secondhand smoke exposure. About a fifth reported some exposure in the previous month. Of 72 saliva samples analyzed, 40% were positive for cotinine, a biomarker of exposure.

Just 17% of all patients recalled that a hospital clinician had inquired about secondhand smoke exposure, and only 1% were counseled to maintain a smoke-free home or car.

The authors write: “It is likely that [secondhand smoke] exposure is similarly overlooked in outpatient cardiology practice. Hospitals and health care systems are missing an opportunity to identify and intervene in this major modifiable cardiovascular risk factor.” A commentator adds: “This is a case in which the electronic health record could make a big difference … through the development of ‘prompts’ to inquire about … exposure and ‘hard stops’ to encourage counseling during what may be a prime teachable moment.”

Link(s):

JAMA Internal Medicine research letter (Subscription required)

JAMA Internal Medicine commentary (Subscription required)

Background: NEJM Journal Watch General Medicine summary on smoking bans and MI risk (Your NEJM Journal Watch registration required)

– See more at: http://www.jwatch.org/fw109516/2014/11/12/clinicians-frequently-miss-opportunities-address?query=topic_substabuse#sthash.Pdktq8VF.dpuf