February 2020

In This Issue: Advancements in VA Primary Care
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Team-Delivered Intervention for Smoking and Hazardous Drinking for Veterans with CVD Treated in Primary Care

Feature Article

Takeaway: The intervention to increase Veterans’ intention to quit smoking and hazardous drinking will fill a gap in care and potentially improve the health and longevity of Veterans seen in VA primary care settings.

Many Veterans (30%) with cardiovascular diseases (CVDs) continue to engage in behaviors that increase risk of cardiovascular events and early mortality, such as smoking or hazardous drinking. While VA has several programs designed to help Veterans quit smoking or quit/reduce drinking, there is a gap in service for Veterans who are not ready for change-based treatments but continue to smoke or drink in a hazardous way. VA Patient Aligned Care Teams (PACTs) screen all patients annually for alcohol and tobacco use, and thus the PACT platform is an ideal way to reach these Veterans. Through the Primary Care Mental Health Integration (PCMHI) initiative, mental and behavioral health providers are embedded to provide effective, evidence-based, Veteran-centered, behavioral health interventions for a variety of co-occurring behavioral health concerns and medical problems.

This ongoing HSR&D study (July 2019 – June 2024) will adapt elements of these evidence-based interventions specifically for a PACT-based VA setting to appeal to Veterans not yet ready to change smoking and/or drinking. The intervention will be piloted in two modes: PACT team-delivered and PCMHI-delivered. Informed by pilot data and a systematic literature review, study investigators will survey local and national stakeholders and experts to understand the preferences, barriers, and facilitators to engaging in conjoint appointments (e.g., PCMHI), and to refine the intervention. They will then design and test this intervention in a small sample and make any necessary modifications before pilot testing the intervention manual in a PACT setting to obtain feedback on the acceptability and feasibility of using evidence-based substance use intervention techniques in real-world clinical practice. Results of this study will inform a larger randomized controlled trial to be conducted later in the study period.

Preliminary Findings

Investigators have surveyed local and national stakeholders and experts to understand the preferences, barriers, and facilitators to engaging in conjoint appointments and have refined the intervention in several ways, including creating clear and flexible handouts and developing training guides for providers.

Impact

This study’s intervention is expected to increase Veterans’ intention to improve rates of smoking and/or drinking cessation, as well as engagement with change-based programs. The intervention will fill a gap in care and potentially improve the health and longevity of Veterans seen in VA primary care settings.  

Principal Investigator: Julie Christina Gass, PhD, part of the VA Western New York Healthcare System in Buffalo, NY, is supported by an HSR&D Career Development Award.

Publications

None to report at this time.

View study abstract