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Research paper
Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration
  1. Sonia A Duffy1,2,3,
  2. Rosalinda V Ignacio2,3,
  3. Hyungjin Myra Kim2,4,
  4. Mark C Geraci5,
  5. Carol A Essenmacher6,
  6. Stephanie V Hall2,
  7. Adam Chow7,
  8. Paul N Pfeiffer2,3,
  9. Scott E Sherman8,9,
  10. Kipling M Bohnert2,3,
  11. Kara Zivin2,3,
  12. Paul George Barnett7
  1. 1 College of Nursing, Ohio State University, Columbus, Michigan, USA
  2. 2 Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
  3. 3 Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
  4. 4 Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan, USA
  5. 5 Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, Illinois, USA
  6. 6 Department of Veterans Affairs, Battle Creek VA Medical Center, Battle Creek, Michigan, USA
  7. 7 Department of Veterans Affairs, Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
  8. 8 Department of Veterans Affairs, VA New York Harbor Healthcare System, New York, New York, USA
  9. 9 Department of Population Health, NYU School of Medicine, New York University, New York, USA
  1. Correspondence to Dr Sonia A Duffy, Ohio State University, College of Nursing, Columbus, OH 43210, USA; duffy.278{at}osu.edu

Abstract

Introduction In 2003, the Veterans Health Administration (VHA) implemented a directive that cessation pharmacotherapy be made available to all who use tobacco and are interested in quitting. Despite the efficacy of cessation pharmacotherapy shown in clinical trials, the generalisability of the results in real-world settings has been challenged. Hence, the specific aim of this study was to determine the effectiveness of cessation pharmacotherapies in the VHA.

Methods This retrospective cohort study used VHA’s electronic medical record data to compare quit rates among those who use tobacco and who did vs. did not receive any type of cessation pharmacotherapy. Included were 589 862 Veterans identified as current tobacco users during fiscal year 2011 who had not received cessation pharmacotherapy in the prior 12 months. Following a 6-month period to assess treatment, quit rates among those who were treated versus untreated were compared during the 7–18 months (12 months) post-treatment follow-up period. The estimated treatment effect was calculated from a logistic regression model adjusting for inverse probability of treatment weights (IPTWs) and covariates. Marginal probabilities of quitting were also obtained among those treated versus untreated.

Results Adjusting for IPTWs and covariates, the odds of quitting were 24% higher among those treated versus untreated (OR=1.24, 95% CI 1.23 to 1.25, p<0.001). The marginal probabilities of quitting were 16.7% for the untreated versus 19.8% for the treated based on the weighted model.

Conclusion The increased quit rates among Veterans treated support the effectiveness and continuation of the VHA tobacco cessation pharmacotherapy policy.

  • cessation
  • health services
  • priority/special populations

https://doi.org/10.1136/tobaccocontrol-2018-054473

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    Footnotes

    • Contributors SAD designed the research study, supervised analysis and drafted and revised the manuscript. RVI analysed the data and wrote the methods and results sections. HMK consulted on statistical methodology and contributed to manuscript preparation. MCG and CAE consulted on pharmacological and clinical aspects smoking cessation, respectively. AC performed data collection and cleaning. SVH, SES, KMB and KZ contributed to manuscript revisions. PGB oversaw statistical analysis, developed the study methods and contributed to manuscript revisions.

    • Funding This work was supported by the Health Services Research and Development Service of the US Department of Veterans Affairs (IIR 14-301) awarded to SAD. In addition, KMB is supported by a Department of Veterans Affairs Health Services Research and Development Service Career Development Award (CDA 11-245). This funding was in the form of an unrestricted allocation. The sponsor did not directly shape the design or conduct of the study, the collection, management, analysis and interpretation of the data, or the preparation, review or approval of the manuscript. The project described was supported by Merit Review Award number I01 HX001764 from the United States Department of Veterans Affairs Health Services Research & Development Service of the VA Office of Research and Development.

    • Disclaimer The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was approved by the Institutional Review Boards (IRBs) at the VHA Ann Arbor and VHA Palo Alto Health Care Systems.

    • Provenance and peer review Not commissioned; externally peer reviewed.