BACKGROUND/RATIONALE:
Among veterans, smoking is the single most important risk factor for preventable mortality and morbidity, and studies suggest a higher prevalence of smoking among veterans than the general population. The VHA has encouraged adoption of the AHCPR Guideline for Smoking Cessation, yet most hospitals have poorly developed smoking cessation programs.

OBJECTIVE(S):
The present study is designed to investigate the effectiveness of an organizational strategy to increase compliance with the AHCPR guideline. Short term goals of the study include increasing the rate of identification of smokers and increasing the delivery of brief smoking cessation interventions. Long term goals include reducing tobacco consumption among veterans.

METHODS:
Twenty VAMC’s with active primary care clinics have been randomly assigned to either control (usual practice; UP) or intervention (organizational support; OS) groups. The intervention hospitals receive staff training and site consultation; all hospitals will receive the AHCPR guideline. Rate of identification of smokers in the medical record, smoking cessation rates, provision of smoking cessation services (e.g., NRT, counseling), and costs of NRT will be determined via telephone interviews with patients, chart review, and electronic records.

FINDINGS/RESULTS:
We hypothesize that our organizational intervention will result in a higher rate of identification of smokers and delivery of smoking cessation services, as well as higher smoking cessation rates when compared to UP hospitals. Results are not yet available.

IMPACT:
We hypothesize that our intervention will lower smoking rates among veterans, thus decreasing veteran morbidity and mortality.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Joseph AM, Arikian NJ, An LC, Nugent SM, Sloan RJ, Pieper CF. Results of a randomized controlled trial of intervention to implement smoking guidelines in Veterans Affairs medical centers: increased use of medications without cessation benefit. Medical care. 2004 Nov 1; 42(11):1100-10. [view]

Conference Presentations

1. Joseph A, Arikian N, An L. Guideline implementation for tobacco. Paper presented at: VA HSR&D National Meeting; 2002 Feb 1; Washington, DC. [view]
2. Joseph AM, Adelson R, An L. Guideline Implementation for Tobacco (GIFT) Study: Increasing treatment of smokers. Paper presented at: Society for Research on Nicotine and Tobacco Annual Conference; 2002 Feb 1; Savannah, GA. [view]
3. Joseph A. Guideline Implementation for Tobacco Study (GIFT). Paper presented at: VA HSR&D Center for Chronic Disease Outcomes Research Staff Annual Meeting; 1999 Sep 10; Minneapolis, MN. [view]

DRA: Substance Use Disorders, Health Systems Science
DRE: Epidemiology
Keywords: Clinical practice guidelines
MeSH Terms: Guidelines