1007 — Facilitation of Tobacco Treatment Implementation in VA Residential Addiction Programs: Impact on Tobacco Dependence Pharmacotherapy

Lead/Presenter: Elizabeth Gifford, COIN - Palo Alto
All Authors: Gifford E (Center for Innovation to Implementation, VA Palo Alto Health Care System) Stephens R (Center for Innovation to Implementation, VA Palo Alto Health Care System) Fuller A (Center for Innovation to Implementation, VA Palo Alto Health Care System) Ellerbe L (Center for Innovation to Implementation, VA Palo Alto Health Care System) Harris A (Program Evaluation and Resource Center, VA Palo Alto Health Care System) Hagedorn H (Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System) Chee C (Health Economics Resource Center, VA Palo Alto Health Care System)

Objectives:
Over 80% of Veterans in SUD residential addiction programs use tobacco, and up to half of long-term smokers will die from a smoking-related illness. In spite of the prevalence and lethality of tobacco dependence (TD), very few residential addiction programs in VA fully integrate tobacco treatment into program services, leaving a critical gap in care for a vulnerable Veteran population. This project investigates whether a facilitation intervention increases evidence-based TD pharmacotherapy implementation in VA residential addiction programs.

Methods:
We identified use of TD pharmacotherapy among all patients discharged from three intervention sites and six control sites during the study period from March 2014 to February 2017 (n = 20,910). During the pre-implementation period, 45% of patients from the intervention sites and 50% of patients from the control sites received TD pharmacotherapy (p = 0.368). Using a difference-in-differences estimation strategy, we estimated the average change in pharmacotherapy rates from the pre-implementation period to the active and post-implementation periods for the intervention sites relative to their matched control sites. Standard errors were adjusted to account for autocorrelation and the staggered implementation of the intervention across the intervention sites and the inclusion of control sites allowed us to control for secular trends in the use of TD pharmacotherapy.

Results:
The tailored facilitation intervention increased the rate of TD pharmacotherapy among patients in the three residential addiction programs by 24% during the active implementation period and 42% during the post-implementation period, relative to the pre-implementation period. The increase in TD pharmacotherapy was driven by an increase in nicotine replacement therapy (NRT; 33% increase in NRT during active implementation and 50% increase during the post-implementation period).

Implications:
Facilitation is a promising approach to increasing evidence-based tobacco pharmacotherapy in VA residential addiction programs, particularly NRT. Tobacco pharmacotherapy implementation increased during active implementation, and these gains continued and grew during the post-implementation period.

Impacts:
Implementing tobacco treatment in VA residential addiction programs will address a highly lethal and undertreated addictive disorder. Facilitation can help residential addiction programs overcome the challenges of implementing evidence-based tobacco pharmacotherapy for Veterans who use tobacco.