Trends and patient characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration

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

Research output: Contribution to journalArticle

Abstract

Introduction: There is evidence suggesting that certain subgroups of people who use tobacco do not receive tobacco pharmacology as consistently as others. Methods: This retrospective, cohort study examined the trend in the use of cessation pharmacotherapy from 2004 to 2013 using Veterans Health Administration (VHA) administrative data. Among Veterans who used tobacco in the fiscal year (FY) 2011 and had not received pharmacotherapy in the prior year, multivariable Cox regression was used to assess the independent associations between patient clinical and demographic characteristics and pharmacotherapy initiation in the 6-months follow-up period. Results: Smoking cessation pharmacotherapy in the VHA increased from 13.8% in 2004 to 25.6% in 2013. In 2011, Veterans (N = 838 309) who were more likely to newly receive pharmacotherapy included those with psychiatric disorders (depression, bipolar disorder, non-alcohol substance use disorder, other anxiety, and post-traumatic stress disorder), chronic pulmonary disease, peripheral vascular disorders, and younger Veterans (adjusted rate ratios (ARRs) ranged from 1.03 to 1.92, all p < .001). Veterans less likely to receive pharmacotherapy were those with schizophrenia or other psychosis, males, Hispanics, and those with a medical condition (uncomplicated diabetes, uncomplicated hypertension, fluid and electrolyte disorders, cardiac arrhythmia, valvular disease, hypothyroidism, acquired immunodeficiency syndrome/human immunodeficiency virus, deficiency anemia, renal failure, paralysis, coagulopathy, metastatic cancer, and other neurological disorders) (ARRs ranged from 0.74 to 0.93, all p < .001). Conclusions: Although VHA cessation pharmacotherapy use nearly doubled from 13.8% in 2004 to 25.6% in 2013, reaching undertreated subgroups, especially those with medical comorbidities, may improve cessation outcomes. Implications: Despite evidence that demographics influence the use of pharmacotherapy in smoking cessation, there is limited and contradictory information regarding how psychiatric and chronic medical illnesses affect pharmacotherapy use. Administrative data were used to determine trends and patient characteristics of those receiving pharmacotherapy to aid in smoking cessation in the Veterans Health Administration. From 2004 to 2013, pharmacotherapy use increased from 13.8% to 25.6% of current smokers. Factors associated with increased pharmacotherapy initiation were psychiatric disorders, chronic pulmonary disease, peripheral vascular disorders, and younger age. Veterans with schizophrenia or other psychosis, males, Hispanics, and most medical conditions were less likely to receive pharmacotherapy.

Original languageEnglish (US)
Pages (from-to)1173-1181
Number of pages9
JournalNicotine and Tobacco Research
Volume20
Issue number10
DOIs
StatePublished - Jan 1 2018

Fingerprint

Veterans Health
United States Department of Veterans Affairs
Tobacco
Drug Therapy
Veterans
Smoking Cessation
Psychiatry
Chronic Disease
Hispanic Americans
Psychotic Disorders
Lung Diseases
Blood Vessels
Schizophrenia
Demography
Tobacco Use
Post-Traumatic Stress Disorders
Hypothyroidism
Nervous System Diseases
Bipolar Disorder
Paralysis

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Ignacio, R. V., Barnett, P. G., Kim, H. M., Geraci, M. C., Essenmacher, C. A., Hall, S. V., ... Duffy, S. A. (2018). Trends and patient characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration. Nicotine and Tobacco Research, 20(10), 1173-1181. https://doi.org/10.1093/ntr/ntx229

Trends and patient characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration. / Ignacio, Rosalinda V.; Barnett, Paul G.; Kim, Hyungjin Myra; Geraci, Mark C.; Essenmacher, Carol A.; Hall, Stephanie V.; Chow, Adam; Pfeiffer, Paul N.; Sherman, Scott; Bohnert, Kipling M.; Zivin, Kara; Duffy, Sonia A.

In: Nicotine and Tobacco Research, Vol. 20, No. 10, 01.01.2018, p. 1173-1181.

Research output: Contribution to journalArticle

Ignacio, RV, Barnett, PG, Kim, HM, Geraci, MC, Essenmacher, CA, Hall, SV, Chow, A, Pfeiffer, PN, Sherman, S, Bohnert, KM, Zivin, K & Duffy, SA 2018, 'Trends and patient characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration', Nicotine and Tobacco Research, vol. 20, no. 10, pp. 1173-1181. https://doi.org/10.1093/ntr/ntx229
Ignacio, Rosalinda V. ; Barnett, Paul G. ; Kim, Hyungjin Myra ; Geraci, Mark C. ; Essenmacher, Carol A. ; Hall, Stephanie V. ; Chow, Adam ; Pfeiffer, Paul N. ; Sherman, Scott ; Bohnert, Kipling M. ; Zivin, Kara ; Duffy, Sonia A. / Trends and patient characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration. In: Nicotine and Tobacco Research. 2018 ; Vol. 20, No. 10. pp. 1173-1181.
@article{695595350de040d9b36c50b5a56a752d,
title = "Trends and patient characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration",
abstract = "Introduction: There is evidence suggesting that certain subgroups of people who use tobacco do not receive tobacco pharmacology as consistently as others. Methods: This retrospective, cohort study examined the trend in the use of cessation pharmacotherapy from 2004 to 2013 using Veterans Health Administration (VHA) administrative data. Among Veterans who used tobacco in the fiscal year (FY) 2011 and had not received pharmacotherapy in the prior year, multivariable Cox regression was used to assess the independent associations between patient clinical and demographic characteristics and pharmacotherapy initiation in the 6-months follow-up period. Results: Smoking cessation pharmacotherapy in the VHA increased from 13.8{\%} in 2004 to 25.6{\%} in 2013. In 2011, Veterans (N = 838 309) who were more likely to newly receive pharmacotherapy included those with psychiatric disorders (depression, bipolar disorder, non-alcohol substance use disorder, other anxiety, and post-traumatic stress disorder), chronic pulmonary disease, peripheral vascular disorders, and younger Veterans (adjusted rate ratios (ARRs) ranged from 1.03 to 1.92, all p < .001). Veterans less likely to receive pharmacotherapy were those with schizophrenia or other psychosis, males, Hispanics, and those with a medical condition (uncomplicated diabetes, uncomplicated hypertension, fluid and electrolyte disorders, cardiac arrhythmia, valvular disease, hypothyroidism, acquired immunodeficiency syndrome/human immunodeficiency virus, deficiency anemia, renal failure, paralysis, coagulopathy, metastatic cancer, and other neurological disorders) (ARRs ranged from 0.74 to 0.93, all p < .001). Conclusions: Although VHA cessation pharmacotherapy use nearly doubled from 13.8{\%} in 2004 to 25.6{\%} in 2013, reaching undertreated subgroups, especially those with medical comorbidities, may improve cessation outcomes. Implications: Despite evidence that demographics influence the use of pharmacotherapy in smoking cessation, there is limited and contradictory information regarding how psychiatric and chronic medical illnesses affect pharmacotherapy use. Administrative data were used to determine trends and patient characteristics of those receiving pharmacotherapy to aid in smoking cessation in the Veterans Health Administration. From 2004 to 2013, pharmacotherapy use increased from 13.8{\%} to 25.6{\%} of current smokers. Factors associated with increased pharmacotherapy initiation were psychiatric disorders, chronic pulmonary disease, peripheral vascular disorders, and younger age. Veterans with schizophrenia or other psychosis, males, Hispanics, and most medical conditions were less likely to receive pharmacotherapy.",
author = "Ignacio, {Rosalinda V.} and Barnett, {Paul G.} 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 Duffy, {Sonia A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1093/ntr/ntx229",
language = "English (US)",
volume = "20",
pages = "1173--1181",
journal = "Nicotine and Tobacco Research",
issn = "1462-2203",
publisher = "Oxford University Press",
number = "10",

}

TY - JOUR

T1 - Trends and patient characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration

AU - Ignacio, Rosalinda V.

AU - Barnett, Paul G.

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 - Duffy, Sonia A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: There is evidence suggesting that certain subgroups of people who use tobacco do not receive tobacco pharmacology as consistently as others. Methods: This retrospective, cohort study examined the trend in the use of cessation pharmacotherapy from 2004 to 2013 using Veterans Health Administration (VHA) administrative data. Among Veterans who used tobacco in the fiscal year (FY) 2011 and had not received pharmacotherapy in the prior year, multivariable Cox regression was used to assess the independent associations between patient clinical and demographic characteristics and pharmacotherapy initiation in the 6-months follow-up period. Results: Smoking cessation pharmacotherapy in the VHA increased from 13.8% in 2004 to 25.6% in 2013. In 2011, Veterans (N = 838 309) who were more likely to newly receive pharmacotherapy included those with psychiatric disorders (depression, bipolar disorder, non-alcohol substance use disorder, other anxiety, and post-traumatic stress disorder), chronic pulmonary disease, peripheral vascular disorders, and younger Veterans (adjusted rate ratios (ARRs) ranged from 1.03 to 1.92, all p < .001). Veterans less likely to receive pharmacotherapy were those with schizophrenia or other psychosis, males, Hispanics, and those with a medical condition (uncomplicated diabetes, uncomplicated hypertension, fluid and electrolyte disorders, cardiac arrhythmia, valvular disease, hypothyroidism, acquired immunodeficiency syndrome/human immunodeficiency virus, deficiency anemia, renal failure, paralysis, coagulopathy, metastatic cancer, and other neurological disorders) (ARRs ranged from 0.74 to 0.93, all p < .001). Conclusions: Although VHA cessation pharmacotherapy use nearly doubled from 13.8% in 2004 to 25.6% in 2013, reaching undertreated subgroups, especially those with medical comorbidities, may improve cessation outcomes. Implications: Despite evidence that demographics influence the use of pharmacotherapy in smoking cessation, there is limited and contradictory information regarding how psychiatric and chronic medical illnesses affect pharmacotherapy use. Administrative data were used to determine trends and patient characteristics of those receiving pharmacotherapy to aid in smoking cessation in the Veterans Health Administration. From 2004 to 2013, pharmacotherapy use increased from 13.8% to 25.6% of current smokers. Factors associated with increased pharmacotherapy initiation were psychiatric disorders, chronic pulmonary disease, peripheral vascular disorders, and younger age. Veterans with schizophrenia or other psychosis, males, Hispanics, and most medical conditions were less likely to receive pharmacotherapy.

AB - Introduction: There is evidence suggesting that certain subgroups of people who use tobacco do not receive tobacco pharmacology as consistently as others. Methods: This retrospective, cohort study examined the trend in the use of cessation pharmacotherapy from 2004 to 2013 using Veterans Health Administration (VHA) administrative data. Among Veterans who used tobacco in the fiscal year (FY) 2011 and had not received pharmacotherapy in the prior year, multivariable Cox regression was used to assess the independent associations between patient clinical and demographic characteristics and pharmacotherapy initiation in the 6-months follow-up period. Results: Smoking cessation pharmacotherapy in the VHA increased from 13.8% in 2004 to 25.6% in 2013. In 2011, Veterans (N = 838 309) who were more likely to newly receive pharmacotherapy included those with psychiatric disorders (depression, bipolar disorder, non-alcohol substance use disorder, other anxiety, and post-traumatic stress disorder), chronic pulmonary disease, peripheral vascular disorders, and younger Veterans (adjusted rate ratios (ARRs) ranged from 1.03 to 1.92, all p < .001). Veterans less likely to receive pharmacotherapy were those with schizophrenia or other psychosis, males, Hispanics, and those with a medical condition (uncomplicated diabetes, uncomplicated hypertension, fluid and electrolyte disorders, cardiac arrhythmia, valvular disease, hypothyroidism, acquired immunodeficiency syndrome/human immunodeficiency virus, deficiency anemia, renal failure, paralysis, coagulopathy, metastatic cancer, and other neurological disorders) (ARRs ranged from 0.74 to 0.93, all p < .001). Conclusions: Although VHA cessation pharmacotherapy use nearly doubled from 13.8% in 2004 to 25.6% in 2013, reaching undertreated subgroups, especially those with medical comorbidities, may improve cessation outcomes. Implications: Despite evidence that demographics influence the use of pharmacotherapy in smoking cessation, there is limited and contradictory information regarding how psychiatric and chronic medical illnesses affect pharmacotherapy use. Administrative data were used to determine trends and patient characteristics of those receiving pharmacotherapy to aid in smoking cessation in the Veterans Health Administration. From 2004 to 2013, pharmacotherapy use increased from 13.8% to 25.6% of current smokers. Factors associated with increased pharmacotherapy initiation were psychiatric disorders, chronic pulmonary disease, peripheral vascular disorders, and younger age. Veterans with schizophrenia or other psychosis, males, Hispanics, and most medical conditions were less likely to receive pharmacotherapy.

UR - http://www.scopus.com/inward/record.url?scp=85055451518&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055451518&partnerID=8YFLogxK

U2 - 10.1093/ntr/ntx229

DO - 10.1093/ntr/ntx229

M3 - Article

VL - 20

SP - 1173

EP - 1181

JO - Nicotine and Tobacco Research

JF - Nicotine and Tobacco Research

SN - 1462-2203

IS - 10

ER -