1122 — National Clinical Dataset Characterizes Changes in Veteran Tobacco Use

Barnett PG, HERC, VA Palo Alto Health Care System; Chow A, HERC, VA Palo Alto Health Care System; Flores N, HERC, VA Palo Alto Health Care System; Duffy S, VA Ann Arbor Health Care System;

Objectives:
A national dataset generated by VA clinical reminders was evaluated to determine if it could be used to identify tobacco use status. Quit rates in current tobacco users and relapse rates in recent quitters were determined, as well as the effect of medical, psychiatric, and substance abuse comorbidities on these rates.

Methods:
Entries of tobacco use status in the Corporate Data Warehouse health factors table from FY 2009-FY2011 were standardized. Longitudinal completeness for current users and recent quitters identified in FY2009 and completeness of point prevalence for FY2011 were examined. Covariates (age, gender, region, diagnosis of chronic illness, tobacco pharmacotherapy) were obtained from administrative data; date of death was obtained from vital status files.

Results:
About 14.4 million tobacco use assessments for 5.0 million unique patients seen over these three years were identified. Among 1.1 million tobacco users identified in FY2009, 4.3% had died and 74.8% had tobacco status re-assessed within 24 months. In those with a follow-up assessment, 24.7% had received tobacco pharmacotherapy and 15.9% reported that they were no longer using tobacco. Pharmacotherapy and cessation were positively correlated with medical illnesses and negatively correlated with psychiatric and substance use diagnoses. Among 73 thousand recent ( < 1 year) quitters, 5.8% died and 71.7% had a follow-up assessment. Relapse occurred in 38.2% and was negatively correlated with medical illnesses and positively correlated with psychiatric and substance use diagnoses. Relapse was less common in longer term quitters. Among 5.7 million users of VA care in FY2011, 4.0 million (70.3%) had a tobacco use status in this dataset.

Implications:
Health factors data contain longitudinal information on tobacco use status and can be used for follow-up in tobacco cessation quality improvement and research studies. Veterans with psychiatric and substance use disorders were less likely to stop using tobacco; if they do quit, they are more likely to relapse than other veterans.

Impacts:
Health factors tobacco use data can identify Veteran tobacco use status, will help facilitate follow-up in effectiveness studies, and will provide more accurate quit and relapse rates needed for accurate long-term models of treatment cost-effectiveness.