Implementing smoking cessation guidelines for hospitalized Veterans

Cessation results from the VA-BEST trial

Mark W. Vander Weg, John E. Holman, Hafizur Rahman, Mary Vaughan Sarrazin, Stephen L. Hillis, Steven S. Fu, Kathleen M Grant, Allan V. Prochazka, Susan L. Adams, Catherine T. Battaglia, Lynne M Buchanan, David Tinkelman, David A. Katz

Research output: Contribution to journalArticle

Abstract

Purpose To examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers. Design Pre-post quasi-experimental trial. Setting General medical units of four US Department of Veterans Affairs hospitals. Subjects 898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively). Intervention The intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback. Measures The primary outcome was self-reported 7-day point prevalence abstinence at six months. Analysis Tobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression. Results Seven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio (AOR) and 95% confidence interval (CI95) = 0.78 [0.51–1.18]) or six months (AOR = 0.92; CI95 = 0.62–1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect (p = 0.0004) and perceived likelihood of staying off cigarettes following discharge (p < 0.0001). Conclusions Tobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.

Original languageEnglish (US)
Pages (from-to)79-88
Number of pages10
JournalJournal of Substance Abuse Treatment
Volume77
DOIs
StatePublished - Jun 1 2017

Fingerprint

Tobacco Use
Veterans
Smoking Cessation
Computerized Medical Records Systems
Odds Ratio
Nurses
Guidelines
Tobacco Use Cessation
Veterans Hospitals
Self Efficacy
Self Care
Tobacco Products
Cluster Analysis
Inpatients
Logistic Models
Smoking
Confidence Intervals

Keywords

  • Clinical practice guidelines
  • Hospitalization
  • Smoking cessation
  • Tobacco use
  • Veterans

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Vander Weg, M. W., Holman, J. E., Rahman, H., Sarrazin, M. V., Hillis, S. L., Fu, S. S., ... Katz, D. A. (2017). Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial. Journal of Substance Abuse Treatment, 77, 79-88. https://doi.org/10.1016/j.jsat.2017.03.015

Implementing smoking cessation guidelines for hospitalized Veterans : Cessation results from the VA-BEST trial. / Vander Weg, Mark W.; Holman, John E.; Rahman, Hafizur; Sarrazin, Mary Vaughan; Hillis, Stephen L.; Fu, Steven S.; Grant, Kathleen M; Prochazka, Allan V.; Adams, Susan L.; Battaglia, Catherine T.; Buchanan, Lynne M; Tinkelman, David; Katz, David A.

In: Journal of Substance Abuse Treatment, Vol. 77, 01.06.2017, p. 79-88.

Research output: Contribution to journalArticle

Vander Weg, MW, Holman, JE, Rahman, H, Sarrazin, MV, Hillis, SL, Fu, SS, Grant, KM, Prochazka, AV, Adams, SL, Battaglia, CT, Buchanan, LM, Tinkelman, D & Katz, DA 2017, 'Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial', Journal of Substance Abuse Treatment, vol. 77, pp. 79-88. https://doi.org/10.1016/j.jsat.2017.03.015
Vander Weg, Mark W. ; Holman, John E. ; Rahman, Hafizur ; Sarrazin, Mary Vaughan ; Hillis, Stephen L. ; Fu, Steven S. ; Grant, Kathleen M ; Prochazka, Allan V. ; Adams, Susan L. ; Battaglia, Catherine T. ; Buchanan, Lynne M ; Tinkelman, David ; Katz, David A. / Implementing smoking cessation guidelines for hospitalized Veterans : Cessation results from the VA-BEST trial. In: Journal of Substance Abuse Treatment. 2017 ; Vol. 77. pp. 79-88.
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abstract = "Purpose To examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers. Design Pre-post quasi-experimental trial. Setting General medical units of four US Department of Veterans Affairs hospitals. Subjects 898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively). Intervention The intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback. Measures The primary outcome was self-reported 7-day point prevalence abstinence at six months. Analysis Tobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression. Results Seven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio (AOR) and 95{\%} confidence interval (CI95) = 0.78 [0.51–1.18]) or six months (AOR = 0.92; CI95 = 0.62–1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect (p = 0.0004) and perceived likelihood of staying off cigarettes following discharge (p < 0.0001). Conclusions Tobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.",
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