Journal article
Implementing Best Evidence in Smoking Cessation Treatment for Hospitalized Veterans: Results from the VA-BEST Trial
Joint Commission journal on quality and patient safety, Vol.40(11), pp.493,AP1-502,AP1
11/2014
DOI: 10.1016/S1553-7250(14)40064-3
PMID: 26111367
Abstract
Although the US Department of Veterans Affairs (VA) has promoted adherence to smoking cessation guidelines since 1997, hospitalized smokers do not consistently receive assistance in quitting.
In a pre-post guideline implementation trial on the inpatient medicine units of four VA hospitals, the effectiveness of a multimodal intervention (enhanced academic detailing, modification of the nursing admission template, patient education materials and quitline referral, practice facilitation and staff feedback) changing practice behavior was evaluated. Peridischarge interviews were conducted with 824 patients to assess receipt of nurses’ and physicians’ delivery of the 5A’s (Ask, Advise, Assess, Assist, Arrange) in hospitalized smokers.
Subjects were significantly more likely to have received each of the 5A’s from a nurse during the postimplementation period (except for “advise to quit”). More patients were assisted in quitting (75% versus 56%, adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.6, 3.1) and had follow-up arranged (23% versus 18%, adjusted OR = 1.5, 95% CI = 1.0, 2.2) by a nurse during the postimplementation period. However, unadjusted results showed no improvement in seven-day point prevalence abstinence at six-month follow-up (13.5% versus 13.9%). Nurses’ self-efficacy in cessation counseling, as measured in a survey of 166unit nurses, improved following guideline implementation.
A multifaceted intervention including enhanced academic detailing is an effective strategy for improving the delivery of smoking cessation services in medical inpatients. To promote long-term cessation, more intensive interventions are needed to ensure that motivated smokers receive guideline-recommended treatment (including pharmacotherapy and referral to outpatient cessation counseling).
Details
- Title: Subtitle
- Implementing Best Evidence in Smoking Cessation Treatment for Hospitalized Veterans: Results from the VA-BEST Trial
- Creators
- David A Katz - Core Investigator, Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa CityJohn E HolmanSkyler R JohnsonStephen L Hillis - Senior Statistician, CADRE CenterSusan L Adams - Formerly Nurse Investigator, CADRE CenterSteven S Fu - Director, Center for Chronic Disease and Outcomes Research, Minneapolis VA Health Care SystemKathleen M Grant - Specialist in Addiction Medicine, VA Nebraska-Western Iowa Health Care System, OmahaLynne M Buchanan - University of Nebraska Medical CenterAllan Prochazka - Professor of Medicine, University of Colorado, DenverCatherine T Battaglia - Assistant Professor, University of ColoradoMarita G Titler - Division of Systems Leadership and Effectiveness Science, University of Michigan School of Nursing, Ann ArborAnne M Joseph - Applied Clinical Research Program, University of MinnesotaMark W Vander Weg - Core Investigator, CADRE Center
- Resource Type
- Journal article
- Publication Details
- Joint Commission journal on quality and patient safety, Vol.40(11), pp.493,AP1-502,AP1
- DOI
- 10.1016/S1553-7250(14)40064-3
- PMID
- 26111367
- NLM abbreviation
- Jt Comm J Qual Patient Saf
- ISSN
- 1553-7250
- eISSN
- 1938-131X
- Publisher
- Elsevier Inc
- Grant note
- name: Department of Veterans Affairs, Office of Research and Development and Health Services Research & Development, award: IIR 07-113
- Language
- English
- Date published
- 11/2014
- Academic Unit
- Radiology; Epidemiology; Psychological and Brain Sciences; Biostatistics; Injury Prevention Research Center; General Internal Medicine; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9984063119902771
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