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- Title
Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration.
- Authors
Blok, Amanda C.; Ignacio, Rosalinda V.; Geraci, Mark C.; Kim, Hyungjin Myra; Barnett, Paul G.; Duffy, Sonia A.
- Abstract
INTRODUCTION While initiation rates of tobacco cessation pharmacotherapy have improved both inside and outside the Department of Veteran Affairs (VA), prescribing rates remain low. The objective of this study was to examine correlation of the characteristics of providers, clinics, and facilities with initiation of tobacco cessation pharmacotherapy. METHODS This retrospective, observational study used VA outpatient electronic medical record data from federal fiscal year 2011. Logistic regression models estimated the adjusted odds ratio associated with provider characteristics for pharmacotherapy initiation. RESULTS For the 639507 veterans who used tobacco, there were 30388 providers caring for them. Younger (p<0.001) and female (p<0.001) providers were more likely to initiate tobacco cessation pharmacotherapy. Compared to physicians, pharmacists were 74% more likely to initiate pharmacotherapy, while all groups of nurses were 5-8% and physicians' assistants were 12% less likely (p<0.001). Compared to those seen in primary care clinics, patients assessed in substance use treatment clinics were 16% more likely to have pharmacotherapy initiated (p<0.001), while those in psychiatry were 10% less likely (p<0.001), and those in outpatient surgery were 39% less likely to initiate pharmacotherapy (p<0.001). Compared to almost all other classes of VA facilities, patients seen in primary care community-based outpatient clinics (CBOCs) were 7-28% more likely to initiate pharmacotherapy (p<0.0001). CONCLUSIONS While the VA is at the leading edge of providing tobacco cessation pharmacotherapy, targeting quality improvement efforts towards providers, clinics, and facilities with low prescribing rates will be essential to continue the declining rates of tobacco use among VA patients.
- Subjects
NICOTINIC agonists; DRUG abstinence; HEALTH facilities; SMOKING cessation; SCIENTIFIC observation; MEDICAL personnel; RETROSPECTIVE studies; COMMUNITY health services; COMPARATIVE studies; PSYCHOSOCIAL factors; DRUG therapy; QUALITY assurance; SMOKING; STATISTICAL correlation; ELECTRONIC health records; LOGISTIC regression analysis; ODDS ratio; VETERANS; UNITED States. Dept. of Veterans Affairs; TOBACCO; SMOKING cessation products
- Publication
Tobacco Induced Diseases, 2021, Vol 19, p1
- ISSN
2070-7266
- Publication type
Article
- DOI
10.18332/tid/140091