3025 — Primary Care Practice and Specialty Features Associated with Improving Smoking Cessation Treatment
Farmer MM (COE for the Study of Healthcare Provider Behavior), Rose DE
(COE for the Study of Healthcare Provider Behavior), Riopelle DD
(COE for the Study of Healthcare Provider Behavior), Lanto AB
(COE for the Study of Healthcare Provider Behavior), Sherman SE
(VA New York Harbor Healthcare System), Yano EM
(COE for the Study of Healthcare Provider Behavior)
Despite VA’s other advances in assessing and counseling smokers, the delivery of smoking cessation treatment for veteran smokers is lower than almost all other rates of preventive care delivery. We evaluated the role of primary care and specialty features on the delivery of guideline-concordant smoking cessation treatment.
We merged patient-level data from the 2007 Survey of Healthcare Experiences of Patients (smokers = 15,033) and organizational-level data from the 2007 VHA Clinical Practice Organization Survey Primary Care Director Module (sites = 225). Smoking cessation treatment was measured from patient reports that a VA provider advised him/her to quit, recommended medications, or recommended other treatments (other than medication) to assist in quitting. Organizational measures included primary care and specialty practice care components specific to smoking cessation. We utilized random-intercept logistic regression, adjusting for patient clustering within facility.
Nationally, 83% of smokers reported they were advised to quit, 62% reported medications, and 60% reported other treatment with substantial variation across facilities (66-97% advised to quit, 39-84% medications, 29-83% other treatment). Sites where follow-up for a smoking diagnosis is coordinated by the primary care provider (OR = 1.15, CI:1.02-1.29) and the management of smokers' care is done principally through primary care (OR = 1.18, CI:1.05-1.31) had higher odds of offering medications than when done outside primary care. Sites where specialty smoking cessation services are available on-site had increased odds of recommending other treatment besides medications (OR = 1.26, CI:1.05-1.52).
Over a third of smoking veterans reported they did not receive medications or other treatment from their VA provider, with sizable variation in treatment rates by facility. VA primary care facilities that took the lead on smoking cessation or had on-site specialty services were more likely to assist smokers in quitting, indicating that a shift in resources to primary care for smoking cessation treatment could lead to more smokers treated.
During the current VA transformation with the PACT initiative, VA managers should be aware that enabling primary care practices to provide medications through formulary expansion and organizational support are central to improving care for our veteran smokers.