Study Shows Proactive Outreach Helps Veterans with PTSD Overcome Barriers to Getting Treatment to Help Quit Smoking
BACKGROUND:
Despite the decline in smoking over the past several decades, smoking still accounts for nearly half a million premature deaths and $300 billion in healthcare costs and lost productivity each year in the U.S. It is estimated that 22% of Veterans are current smokers and smoking accounts for 11% of all VA inpatient healthcare costs. The health and economic consequences of tobacco use disproportionately impact Veterans with mental health disorders, including PTSD. This was a secondary analysis of a randomized controlled trial (RCT)–conducted from 2013 to 2017–that demonstrated the effectiveness of proactive outreach for increasing smoking abstinence among Veterans using VA mental healthcare services. [Proactive outreach is designed to reduce barriers to smoking cessation treatment through direct engagement with patients.] Using VA's electronic medical record data, investigators in the present study identified RCT participants with (n=355) and without (n=1,583) PTSD and evaluated the proactive outreach intervention for increasing treatment utilization and smoking abstinence among these Veterans. Participants were randomized to the intervention (outreach and facilitated access to evidence-based smoking cessation treatments, including nicotine replacement therapy) or usual care (participants were mailed a list of local smoking cessation services, and had access to cessation treatments). Investigators also examined patient demographics, smoking history, cessation beliefs, and mental health.
FINDINGS:
- Compared to usual care, proactive outreach increased combined counseling and nicotine replacement therapy use among Veterans with PTSD (19% vs 1%) and without PTSD (15% vs 2%).
- For the primary abstinence outcome, Veterans randomized to proactive outreach reported higher rates of 7-day point prevalence abstinence at 12 months in both the PTSD (21% vs 9%) and non-PTSD groups (19% vs 15%).
- Smokers with and without PTSD were similarly likely to respond to the initial outreach call (74% vs. 75%) and to schedule an appointment for counseling (41% in both groups).
IMPLICATIONS:
- Findings suggest that proactive outreach may help overcome barriers to treatment utilization and smoking cessation among Veterans with PTSD. Further, given the documented cost-effectiveness of proactive outreach, future work should focus on the development of strategies to enable more widespread implementation of these interventions.
LIMITATIONS:
- It is not possible to determine which components of the proactive outreach intervention contributed to the heightened rates of treatment utilization and abstinence in this study cohort.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (IIR 11-291). Dr. Hammett is part of HSR&D’s Center for Care Delivery and Outcomes Research (CCDOR) in Minneapolis, MN; Dr. Fu is Director of CCDOR; Dr. Sherman is part of the VA NY Harbor Healthcare System (Manhattan campus).
Hammett P, Japuntich S, Sherman S, Rogers ES, Danan ER, Noorbaloochi S, El-Shahawy O, Burgess DJ, Fu SS. Proactive Tobacco Treatment for Veterans with Posttraumatic Stress Disorder. Psychological Trauma: Theory, Research, Practice, and Policy. July 2, 2020;epub ahead of print.
