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BACKGROUND/RATIONALE:
Smoking cessation services in the Department of Veterans Affairs (VA) are currently provided via outpatient groups or, in some cases, medications by patients' physicians. However, inconsistent or minimal cessation services are provided to inpatients in the VA system and this has been noted as a deficit area. Inpatient smoking cessation programs that include counseling and medications have been shown to be efficacious both inside and outside of the VA. Nurse-administered cessation interventions have been shown to be more efficacious than interventions delivered by non-nurse counselors, but they have not been tested in the VA.
OBJECTIVE(S):
The objective of this SDP is to implement and evaluate an inpatient, nurse-administered cessation program in the three largest VISN 11 hospitals. Specifically, the objectives are to (1) determine provider receptivity and barriers to implementing a nurse-administered inpatient smoking cessation intervention by face-to-face contact and surveys; (2) determine patient receptivity and barriers to implementing the intervention by surveys; and (3) determine the effectiveness of the intervention compared to usual care using 6-month confirmed cessation as the primary outcome.
METHODS:
This is an implementation study using a quasi-experimental design in the three largest VISN 11 hospitals. Patients admitted to the Ann Arbor and Detroit VAs will receive the smoking intervention, while patients admitted to Indianapolis will receive usual care. During the implementation phase, a research nurse will hold a series of training sessions for nurses on all three shifts, conduct formative (process) evaluation, and tailor the intervention to the needs of the VA. During the evaluation phase, the research nurses will be withdrawn from the units and sustainability and summative (outcome) evaluation of the intervention will be conducted. The intervention includes physician advice to quit smoking, nurse counseling and educational materials (videotape and workbook), nicotine replacement therapy, Bupropion, and/or Varenicline, and follow-up phone calls. Smokers in all facilities (experimental and control) will be surveyed at baseline and 6 months after discharge about their smoking habits and (at 6 months only) the types of cessation services they received while in the hospital.
FINDINGS/RESULTS:
Indianapolis, the control site, is recruiting patients to determine baseline smoking rates. The Detroit intervention site has recruited patients to determine baseline smoking rates, and the research nurse has trained 94 nurses. Nurse training is ongoing at the Detroit VA. Training is complete at the Ann Arbor VA; 96% (210/219) of inpatient nurses have been trained, and we are evaluating the program by distributing surveys to nurses and obtaining face-to-face feedback. Over 1000 subjects have agreed to participate in the study. Follow-up surveys are being mailed 6 months after subjects complete the baseline survey.
IMPACT:
The end product will be a carefully evaluated, portable toolkit for a nurse-administered cessation intervention that is tailored to the needs of the VA that will include a manual for nurses, pharmaceutical protocols, videotape and patient workbook, protocol for follow-up phone calls, and recommendations for implementation in VA facilities. If effective, nurse-delivered smoking cessation services have the potential to reduce cardiovascular disease, cancer, and ultimately morbidity and mortality rates in the VA.
PUBLICATIONS:
None at this time.
DRA:
Substance Abuse, Addictive Disorders
DRE:
Resource Use and Cost, Prevention, Treatment
Keywords:
Cost effectiveness, Smoking
MeSH Terms:
Smoking Cessation
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