Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial.

Autor: Vander Weg MW; Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States; University of Iowa Department of Psychological and Brain Sciences, United States. Electronic address: mark-vanderweg@uiowa.edu., Holman JE; Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States., Rahman H; Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States., Sarrazin MV; Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States., Hillis SL; Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Biostatistics, United States; University of Iowa Department of Radiology, United States., Fu SS; Center for Chronic Disease and Outcomes Research (CCDOR), Minneapolis VA Health Care System, United States., Grant KM; Mental Health and Behavioral Sciences Department, VA Nebraska-Western Iowa Health Care System, United States; The Department of Internal Medicine, University of Nebraska Medical Center, United States., Prochazka AV; Department of Medicine, VA Eastern Colorado Health Care System, United States; The Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States., Adams SL; Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States., Battaglia CT; Department of Medicine, VA Eastern Colorado Health Care System, United States; The Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States., Buchanan LM; The College of Nursing, University of Nebraska, United States., Tinkelman D; National Jewish Health, Denver, CO, United States., Katz DA; Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States; University of Iowa Department of Epidemiology, United States.
Jazyk: angličtina
Zdroj: Journal of substance abuse treatment [J Subst Abuse Treat] 2017 Jun; Vol. 77, pp. 79-88. Date of Electronic Publication: 2017 Apr 04.
DOI: 10.1016/j.jsat.2017.03.015
Abstrakt: Purpose: To examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers.
Design: Pre-post quasi-experimental trial.
Setting: General medical units of four US Department of Veterans Affairs hospitals.
Subjects: 898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively).
Intervention: The intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback.
Measures: The primary outcome was self-reported 7-day point prevalence abstinence at six months.
Analysis: Tobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression.
Results: Seven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio (AOR) and 95% confidence interval (CI 95 )=0.78 [0.51-1.18]) or six months (AOR=0.92; CI 95 =0.62-1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect (p=0.0004) and perceived likelihood of staying off cigarettes following discharge (p<0.0001).
Conclusions: Tobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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