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BACKGROUND/RATIONALE:
Psychiatric/substance abuse comorbidities, common among veterans, are associated with increased smoking which contributes to elevated mortality rates from cancer, cardiovascular disease, and hepatic disorders. Compared to nonsmokers, smokers have twice as many hospital stays, have longer hospital stays, and incur greater expenses per admission. The total cost of annual medical services for smokers is estimated at $75.5 billion dollars with another $92 billion estimated in lost productivity. Treatment of heart attacks and strokes is expensive, especially in the VA where patients have less social support and economic resources. Compared with other preventive and invasive interventions, cessation programs represent one of the most cost-effective chronic disease prevention interventions.
OBJECTIVE(S):
Our currently funded Service Directed Project “Inpatient Smoking Cessation: Bringing the Program to the Smoker” is a nurse administered cessation intervention designed for general hospital inpatients, but does not include psychiatric, substance abuse, or outpatient clinics all of whom have asked to be included in this study. Therefore, we are working with providers to identify how to modify the intervention to meet the needs of mental health, substance abuse, and outpatient clinics. Given that smoking is life threatening, treatable, and expensive for the VA, the roll out of cessation services should not be delayed for psychiatric, substance abuse, and outpatients.
METHODS:
This will be a pre- post- non-randomized control design. Ann Arbor and Detroit will be the intervention sites. Indianapolis will be the control site. Approximately 300 psychiatric/substance abuse inpatients and outpatients and 300 general outpatients are expected to be enrolled. The evidence-based intervention is packaged into a toolkit for nurses and patients. Different from our ongoing general inpatient cessation study which is designed to implement the intervention within the first day or so after admission, we are working with providers as to when and how best to approach psychiatric/substance abuse and outpatient clinic patients. Once refined, the intervention will be standard of care and be taught to staff nurses by research nurses (using the train the trainer model) in the two intervention sites, while the control site will continue with usual care.
Formative evaluation will include summaries of patient and staff feedback and means and frequencies from patient and staff surveys, all of which will be reviewed monthly to modify the intervention as needed. Summative evaluation will include a comparison of quit rates in the experimental and control sites using logistic regression. Sub-analyses will be conducted to determine differences in quit rates among smokers (e.g. by diagnostic category) and by units. A cost effectiveness analysis (cost per quitter and cost per life-year, and cost per quality-adjusted life-year) will also be conducted.
FINDINGS/RESULTS:
At this point, the Indianapolis control site is collecting data, we have trained 22 inpatient psychiatric nurses, 46 outpatient staff, and 43 outpatient psychiatric staff to provide smoking cessation services at the Ann Arbor VA, and training is just starting at the Detroit VA.
IMPACT:
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:
Prevention
Keywords:
Smoking
MeSH Terms:
none
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