Session number: 1077
Abstract title: GIFT (Guideline Implementation for Tobacco) Study: Increasing Treatment of Smokers
Author(s):
AM Joseph - Minneapolis CCDOR, Minneapolis VAMC, Univ of Minnesota
NJ Arikian - Minneapolis CCDOR, Minneapolis VAMC
LC An - University of Minnesota
SM Nugent - Minneapolis CCDOR, Minneapolis VAMC
RJ Sloane - Center on Aging and Human Development, Duke University Medical Center
CF Pieper - Center on Aging and Human Development, Duke University Medical Center
GIFT Research Group - Department of Veterans Affairs
Objectives: AHCPR released an evidence-based Smoking Cessation Clinical Practice Guideline in 1996. The objective of GIFT is to test the effectiveness of an organizational strategy (OS) to increase compliance with the Guideline.
Methods: Twenty VAMCs were randomly assigned to 1) usual practice (Guideline dissemination) (UP), or 2) organizational support (OS) that provided training and consultation to promote routine intervention for tobacco users. OS emphasized identifying smokers in the medical record, brief intervention, and drug therapy. A random sample of patients with a recent primary care visit was identified at baseline (n=5793) and another sample was identified one year later (n=1890). A cohort of smokers from baseline was followed (n=763). Data were collected by telephone survey, paper and electronic medical record review, mail survey of primary care and smoking cessation clinic leadership, and from Pharmacy Benefits Management (PBM).
Results: Response rates for the three telephone surveys were 79.3%, 83.9%, and 87.4%. At baseline, 23.6% of subjects were current smokers. After one year, 84.3% of baseline smokers in the OS group reported being asked at their last visit about smoking status (McNemar Odds Ratio (OR)=0.84, for ‘asked’ at baseline vs. follow-up), compared to 80.34% in the UC group (McNemar OR=0.75, P(difference in OR)=0.77). In the OS group, 44.0% of the smokers reported that they were provided counseling at their most recent visit (McNemar OR=2.67 for ‘counsel’ baseline vs. follow-up), compared to 42.2% in the UC group (McNemar OR=1.19, P(difference in OR)=0.014). In OS sites, the rate of treatment with pharmacological therapy and the number of courses of treatment/patient increased, while they decreased in UC sites (P=0.017, and P=0.038, respectively). The one-year cessation rate was 11.4% in the OS group, compared to 13.2% in UC (P=0.51).
Conclusions: We conclude that the OS intervention significantly increased the delivery of behavioral and pharmacological treatment for tobacco dependence. The data failed to demonstrate, however, an increase in the one-year smoking cessation rate.
Impact statement: OS to increase counseling of smokers and availability of drug therapy is relatively easy to accomplish. Implementation of this strategy will increase the treatment of smokers. Smoking cessation rates should be followed in a larger sample to determine effectiveness.