Session number: 1012
Abstract title: Impact of VA Smoking Cessation Initiatives on Smoking Cessation Practices and Outcomes
Author(s):
EM Yano - Center for the Study of Healthcare Provider Behavior
BF Simon - Center for the Study of Healthcare Provider Behavior
AB Lanto - Center for the Study of Healthcare Provider Behavior
SE Sherman - Center for the Study of Healthcare Provider Behavior
Objectives: Given the press of national initiatives and local incentives to improve smoking cessation care in VA, we evaluated the overall changes in smoking-cessation (SC) practice and outcomes among a cohort of smokers seen in VA primary care (PC) practices.
Methods: As part of an evaluation of guideline-implementation strategies, we randomly sampled, consented, screened and surveyed veteran users with 3+ PC visits at 18 southwestern VAs (n=2,018 smokers). Using computer-assisted-telephone-interviewing, we queried smokers about SC treatment (eg, counseling), attitudes, and quit attempts/rates using previously validated items. To date, 12-month follow-up interviews have been completed on a subsample of the original cohort (n=821). We analyzed pre-post changes in this subsample using paired-samples t-tests.
Results: In one year, veterans reported that they smoked less often (p<.0001), delayed their first waking cigarette (p<.05), found it less difficult to smoke in prohibited places (p<.001) and were less likely to wake up in the middle of night and smoke (p<.0001) or to have been asked not to smoke by someone (p<.0001). They were more likely to agree that smoking was harming their health (p<.0001), that families preferred they quit (p<.005), and to ascribe health problems to their smoking (p<.05). Smokers reported that their VA doctors were more likely to have talked to them about quitting (p<.005) and suggest self-help measures (p=.053); however, they were more likely to attend a VA SC clinic on their own (p<.001). Quit attempts doubled (p<.05) and veterans were more likely to report they had quit smoking for 1+ days (p<.0001). While smokers reported no changes in overall health status, they were less likely to stay in bed because of illness/injury (p<.005), and, when in bed, spent fewer days (p<.0001).
Conclusions: Quality improvement initiatives to improve smoking cessation care and outcomes have made significant inroads among VA primary care patients. The extent to which further interventions, such as evidence-based-quality-improvement approaches to guideline implementation, provide added-value will be evaluated when follow-up is complete.
Impact statement: Patient reports of increased smoking cessation counseling and treatment corroborate chart-based performance measures and provide details regarding their readiness-to-change that may facilitate provision of effective counseling by primary care providers.