Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration

Sonia A. Duffy, Rosalinda V. Ignacio, Hyungjin Myra Kim, Mark C. Geraci, Carol A. Essenmacher, Stephanie V. Hall, Adam Chow, Paul N. Pfeiffer, Scott Sherman, Kipling M. Bohnert, Kara Zivin, Paul George Barnett

    Research output: Contribution to journalArticle

    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.

    Original languageEnglish (US)
    JournalTobacco Control
    DOIs
    StateAccepted/In press - Jan 1 2018

    Fingerprint

    Tobacco Use Cessation
    Veterans Health
    United States Department of Veterans Affairs
    nicotine
    Drug Therapy
    health
    Tobacco Use
    Veterans
    Logistic Models
    Therapeutics
    Weights and Measures
    Electronic Health Records
    logistics
    electronics
    regression
    Tobacco
    Cohort Studies
    Retrospective Studies
    Clinical Trials

    Keywords

    • cessation
    • health services
    • priority/special populations

    ASJC Scopus subject areas

    • Health(social science)
    • Public Health, Environmental and Occupational Health

    Cite this

    Duffy, S. A., Ignacio, R. V., Kim, H. M., Geraci, M. C., Essenmacher, C. A., Hall, S. V., ... Barnett, P. G. (Accepted/In press). Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration. Tobacco Control. https://doi.org/10.1136/tobaccocontrol-2018-054473

    Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration. / Duffy, Sonia A.; Ignacio, Rosalinda V.; Kim, Hyungjin Myra; Geraci, Mark C.; Essenmacher, Carol A.; Hall, Stephanie V.; Chow, Adam; Pfeiffer, Paul N.; Sherman, Scott; Bohnert, Kipling M.; Zivin, Kara; Barnett, Paul George.

    In: Tobacco Control, 01.01.2018.

    Research output: Contribution to journalArticle

    Duffy, SA, Ignacio, RV, Kim, HM, Geraci, MC, Essenmacher, CA, Hall, SV, Chow, A, Pfeiffer, PN, Sherman, S, Bohnert, KM, Zivin, K & Barnett, PG 2018, 'Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration', Tobacco Control. https://doi.org/10.1136/tobaccocontrol-2018-054473
    Duffy, Sonia A. ; Ignacio, Rosalinda V. ; Kim, Hyungjin Myra ; Geraci, Mark C. ; Essenmacher, Carol A. ; Hall, Stephanie V. ; Chow, Adam ; Pfeiffer, Paul N. ; Sherman, Scott ; Bohnert, Kipling M. ; Zivin, Kara ; Barnett, Paul George. / Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration. In: Tobacco Control. 2018.
    @article{51128ef0192d4fb4bdedd05bc3f54c11,
    title = "Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration",
    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.",
    keywords = "cessation, health services, priority/special populations",
    author = "Duffy, {Sonia A.} and Ignacio, {Rosalinda V.} and Kim, {Hyungjin Myra} and Geraci, {Mark C.} and Essenmacher, {Carol A.} and Hall, {Stephanie V.} and Adam Chow and Pfeiffer, {Paul N.} and Scott Sherman and Bohnert, {Kipling M.} and Kara Zivin and Barnett, {Paul George}",
    year = "2018",
    month = "1",
    day = "1",
    doi = "10.1136/tobaccocontrol-2018-054473",
    language = "English (US)",
    journal = "Tobacco Control",
    issn = "0964-4563",
    publisher = "BMJ Publishing Group",

    }

    TY - JOUR

    T1 - Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration

    AU - Duffy, Sonia A.

    AU - Ignacio, Rosalinda V.

    AU - Kim, Hyungjin Myra

    AU - Geraci, Mark C.

    AU - Essenmacher, Carol A.

    AU - Hall, Stephanie V.

    AU - Chow, Adam

    AU - Pfeiffer, Paul N.

    AU - Sherman, Scott

    AU - Bohnert, Kipling M.

    AU - Zivin, Kara

    AU - Barnett, Paul George

    PY - 2018/1/1

    Y1 - 2018/1/1

    N2 - 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.

    AB - 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.

    KW - cessation

    KW - health services

    KW - priority/special populations

    UR - http://www.scopus.com/inward/record.url?scp=85053131227&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85053131227&partnerID=8YFLogxK

    U2 - 10.1136/tobaccocontrol-2018-054473

    DO - 10.1136/tobaccocontrol-2018-054473

    M3 - Article

    JO - Tobacco Control

    JF - Tobacco Control

    SN - 0964-4563

    ER -