Aconselhamento sobre o uso de tabaco no contexto de doenças oculares associadas à tireoide

Schatz, Michael Jay; McGeehan, Brendan C.; Maguire, Maureen G.; Briceño, César A.

doi:10.5935/0004-2749.20220003

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ORIGINAL ARTICLE • Arq. Bras. Oftalmol. 85 (1) • Jan-Feb 2022 • https://doi.org/10.5935/0004-2749.20220003 copiar

Aconselhamento sobre o uso de tabaco no contexto de doenças oculares associadas à tireoide

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Fornecer informações sobre a ocorrência e a eficácia do aconselhamento sobre o uso de tabaco por oftalmologistas a pacientes com doenças oculares associadas à tireoide.

Métodos:

Analisamos os prontuários médicos eletrônicos de uma coorte digital de pacientes atendidos por oftalmologistas no Sistema de Saúde da Universidade da Pensilvânia entre o início de 2012 e o final de 2017 com os códigos da Classificação Internacional de Doenças (CID) para a doença de Graves, exoftalmia tireotóxica ou doença ocular associada à tireoide. Os históricos de uso de tabaco foram registrados na primeira e na última visita ao consultório de Oftalmologia, ou na visita mais próxima no tempo. A quantidade de maços/dia (mpd) e todas as anotações feitas nas visitas ao consultório de Oftalmologia foram analisadas para aconselhamento sobre o uso de tabaco.

Resultados:

Um total de 435 indivíduos preencheram os critérios de inclusão, dos quais 72 (16,6%) estavam fumando ativamente no momento do primeiro encontro. Apenas 57 (79,2%) desses indivíduos que fumam ativamente registraram queixas relacionadas ao tabagismo, sendo que 34 (59,6%) deles receberam alguma forma de aconselhamento sobre o uso de tabaco. Ao todo, 9 (26,5%) indivíduos dentre os que receberam aconselhamento sobre tabaco e 1 (4,3%) que não teve aconselhamento registrado pararam de fumar (diferença de risco de 22,1%; IC 95%, [1,7%, 39,1%]; p=0,04). Dentre aqueles que receberam aconselhamento, 17 (50,0%) reduziram seus mpd, além de 7 (30,4%) daqueles que não tiveram aconselhamento (diferença de risco de 19,6%; IC 95% [-6,3%, 41,3%]; p=0,18). No geral, 14 (25,5%) dos 55 oftalmologistas que tiveram um paciente fumante ativo registraram evidências de aconselhamento sobre o uso de tabaco.

Conclusões:

Os resultados deste estudo revelam tanto as oportunidades perdidas de aconselhamento sobre o uso do tabaco quanto a eficácia do aconselhamento no contexto de doenças oculares associadas à tireoide.

Descritores:
Uso de tabaco; Aconselhamento; Doenças da glândula tireóide; Doença de Graves; Oftalmopatias

	Description	Example
Recommendation of anti-smoking medications	The patient is a current smoker and was offered some form medical-assisted therapies for quitting the use of tobacco products, including, but are not limited to varenicline (CHANTIX ^® , Pfizer, Mission, Kansas, USA), bupropion (Zyban ^® , GlaxoSmithKline, Philadelphia, PA, USA), and nicotine-replacement therapies.	A prescription for Chantix was included in the assessment and plan.
Referral to another provider for tobacco cessation	The patient is a current smoker and was referred to another healthcare professional for the purposes of facilitating quitting of the use of tobacco products.	"...will contact PCP re: smoking cessation strategies."
Education on risk	The importance of avoiding tobacco products was explained to the patient.	"[T]he patient was counseled about deleterious effects of smoking and its implications in worsening of the eye disease." "...the risk of blindness discussed." "[Patient] instructed to avoid smoking."
Written materials provided	The patient was provided written materials on the harmful effects of tobacco and/or tips for quitting.	"Written material on thyroid eye disease and adverse effects of smoking provided to the patient."

	All patients			Patients smoking status at initial visit
Characteristic	Female (N=365)	Male (N=70)	Total (N=435)	Female (N=63)	Male (N=9)	Total (N=72)
Age (years)
- Mean (SD)	52.1 (14.6)	53.5 (17.3)	52.4 (15.1)	52.2 (10.7)	48.0 (11.7)	51.6 (10.9)
- Median (Q1, Q3)	53 (43, 62)	55.5 (42, 64)	53 (43, 63)	52 (45.5, 57.5)	49 (40, 53)	51.5 (44.8, 57.2)
- Range	18-91	18-90	18-91	29-74	32-65	29-74
Race, n (%)
- Asian	24 (6.6%)	5 (7.1%)	29 (6.7%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
- Black	142 (38.9%)	7 (10.0%)	149 (34.3%)	35 (55.6%)	2 (22.2%)	37 (51.4%)
- Other	32 (8.8%)	11 (15.7%)	43 (9.9%)	2 (3.2%)	3 (33.3%)	5 (6.9%)
- White	167 (45.8%)	47 (67.1%)	214 (49.2%)	26 (41.3%)	4 (44.4%)	30 (41.7%)
Ethnicity, n (%)
- Hispanic	6 (1.6%)	4 (5.7%)	10 (2.3%)	1 (1.6%)	2 (22.2%)	3 (4.2%)
- Non-Hispanic	358 (98.1%)	66 (94.3%)	424 (97.5%)	62 (98.4%)	7 (77.8%)	69 (95.8%)
- Unknown	1 (0.3%)	0 (0.0%)	1 (0.2%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Language, n (%)
- English	355 (97.3%)	64 (91.4%)	419 (96.3%)	62 (98.4%)	7 (77.8%)	69 (95.8%)
- Other	10 (2.7%)	6 (8.6%)	16 (3.7%)	1 (1.6%)	2 (22.2%)	3 (4.2%)
Interpreter, n (%)
- No	360 (98.6%)	67 (95.7%)	427 (98.2%)	62 (98.4%)	8 (88.9%)	70 (97.2%)
- Yes	5 (1.4%)	3 (4.3%)	8 (1.8%)	1 (1.6%)	1 (11.1%)	2 (2.8%)
Initial Smoking Burden (packs per day)
- N-Missing	53	8	61	14	0	14^* * There were only 14 patients with missing initial smoking burdens, but a total of 15 patients had missing initial and/or final smoking burdens.
- Mean (SD)	0.11 (0.30)	0.09 (0.26)	0.10 (0.30)	0.66 (0.45)	0.61 (0.40)	0.65 (0.44)
- Median (Q1, Q3)	0.00 (0.00, 0.00)	0.00 (0.00, 0.00)	0.00 (0.00, 0.00)	0.50 (0.50, 1.00)	0.50 (0.50, 0.50)	0.50 (0.50, 1.00)
- Range	0.00-2.00	0.00-1.50	0.00-2.00	0.025-2.0	0.20-1.5	0.025-2.0
Follow-up time (years)
- N-Missing	51	10	61	10	2	12
- Mean (SD)	2.8 (3.0)	1.9 (2.5)	2.6 (2.9)	2.4 (2.9)	1.6 (1.8)	2.3 (2.8)
- Median (Q1, Q3)	1.7 (0.2, 4.7)	0.9 (0.0, 2.4)	1.5 (0.1, 4.4)	1.4 (0, 4.0)	0.8 (0.4, 2.3)	1.3 (0.0, 3.9)

Any ophthalmology office visit with	Smoking status
Any ophthalmology office visit with	Current (N=72) n (%)		Former (N=134) n (%)		Never (N=229) n (%)
Recommendation of anti-smoking medications	1	(1.4)	0	(0.0)	0	(0.0)
Referral to another provider for tobacco cessation	2	(2.8)	0	(0.0)	0	(0.0)
Education on risk	36	(50.0)	31	(23.1)	32	(14.0)
Written materials provided	4	(5.6)	1	(0.8)	0	(0.0)
Any of the above^ This reflects the number of patients with at least one of any kind of tobacco counseling efforts. It is not the sum of other categories due to an overlap.	36	(50.0)	31	(23.1)	32	(14.0)

Change in smoking	Patients initially smoking		Received tobacco counseling
Change in smoking	All (N= 57) n (%)		Yes (N=34) n (%)	No (N=23) n (%)
Quit smoking	10	(17.5)	9 (26.5)	1 (4.3)
Reduction in packs per day	24	(42.1)	17 (50.0)	7 (30.4)
No change	31	(54.4)	0 (0.0)	2 (8.7)
Increase in packs per day	2	(3.5)	17 (50.0)	14 (60.9)

Any ophthalmology office visit with	Ophthalmologists (N=55) n (%)
Recommendation of anti-smoking medications	1 (1.8)
Referral to another provider for tobacco cessation	3 (5.5)
Education on risk	14 (25.5)
Written materials provided	1 (1.8)
Any of the above	14 (25.5)

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E-mail: abo@cbo.com.br

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[1] Corresponding author: César A. Briceño. E-mail: cesar.briceno@pennmedicine.upenn.edu