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Impact of VA Smoking Cessation Initiatives on Smoking Cessation Practices and Outcomes
Yano EM, Lanto AB, Simon BF, Sherman SE. Impact of VA Smoking Cessation Initiatives on Smoking Cessation Practices and Outcomes. Paper presented at: VA HSR&D National Meeting; 2002 Feb 1; Washington, DC.
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.