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Results of a randomized controlled trial of intervention to implement smoking guidelines in Veterans Affairs medical centers: increased use of medications without cessation benefit.
Med Care. 2004 Nov; 42(11):1100-10.MC

Abstract

BACKGROUND

The AHRQ Clinical Practice Guideline for Treating Tobacco Use and Dependence recommends screening and treatment of all tobacco users. Effective methods to implement recommendations are needed because simple guideline dissemination does not necessarily result in changes in practice.

OBJECTIVES

The Guideline Implementation for Tobacco (GIFT) study tested an organizational intervention to improve Guideline implementation.

RESEARCH DESIGN

GIFT randomized 20 Veterans Affairs medical centers to intervention or control conditions. We trained prime movers at each site to improve identification of smoking status, promote primary care interventions and increase availability of smoking cessation medications. Sites and patients were evaluated before and after intervention.

SUBJECTS

GIFT included 20 Veterans Affairs medical centers and 5678 subjects.

MEASURES

Data regarding smoking status, delivery of treatment, medication use, and smoking cessation were collected from participant surveys, medical record review, survey of site leaders, and Pharmacy Benefits Management.

RESULTS

The intervention did not increase participant report of being asked about smoking status or receipt of counseling. It did increase the rate of identification of smoking status in the medical record (P = 0.0001) but did not increase the rate of counseling to stop smoking. Site level data showed no increase in the number of patients receiving smoking cessation medications or dollars spent on medications. Individual smoker data showed a significant increase in the use of medications for smoking cessation in intervention sites (odds ratio = 6.89, P < 0.0001); however, only a small minority of smokers received medication even after the intervention. There was no difference in smoking cessation rates between participants at the intervention and treatment sites.

CONCLUSIONS

We conclude that improvements in smoking cessation rates are likely to require more intensive intervention in this population.

Authors+Show Affiliations

VA Medical Center, Section of General Intemal Medicine, Minneapolis, MN 55417, USA. Anne.M.Joseph@med.va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

15586837

Citation

Joseph, Anne M., et al. "Results of a Randomized Controlled Trial of Intervention to Implement Smoking Guidelines in Veterans Affairs Medical Centers: Increased Use of Medications Without Cessation Benefit." Medical Care, vol. 42, no. 11, 2004, pp. 1100-10.
Joseph AM, Arikian NJ, An LC, et al. Results of a randomized controlled trial of intervention to implement smoking guidelines in Veterans Affairs medical centers: increased use of medications without cessation benefit. Med Care. 2004;42(11):1100-10.
Joseph, A. M., Arikian, N. J., An, L. C., Nugent, S. M., Sloan, R. J., & Pieper, C. F. (2004). Results of a randomized controlled trial of intervention to implement smoking guidelines in Veterans Affairs medical centers: increased use of medications without cessation benefit. Medical Care, 42(11), 1100-10.
Joseph AM, et al. Results of a Randomized Controlled Trial of Intervention to Implement Smoking Guidelines in Veterans Affairs Medical Centers: Increased Use of Medications Without Cessation Benefit. Med Care. 2004;42(11):1100-10. PubMed PMID: 15586837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Results of a randomized controlled trial of intervention to implement smoking guidelines in Veterans Affairs medical centers: increased use of medications without cessation benefit. AU - Joseph,Anne M, AU - Arikian,Nancy J, AU - An,Larry C, AU - Nugent,Sean M, AU - Sloan,Richard J, AU - Pieper,Carl F, AU - ,, PY - 2004/12/14/pubmed PY - 2005/1/19/medline PY - 2004/12/14/entrez SP - 1100 EP - 10 JF - Medical care JO - Med Care VL - 42 IS - 11 N2 - BACKGROUND: The AHRQ Clinical Practice Guideline for Treating Tobacco Use and Dependence recommends screening and treatment of all tobacco users. Effective methods to implement recommendations are needed because simple guideline dissemination does not necessarily result in changes in practice. OBJECTIVES: The Guideline Implementation for Tobacco (GIFT) study tested an organizational intervention to improve Guideline implementation. RESEARCH DESIGN: GIFT randomized 20 Veterans Affairs medical centers to intervention or control conditions. We trained prime movers at each site to improve identification of smoking status, promote primary care interventions and increase availability of smoking cessation medications. Sites and patients were evaluated before and after intervention. SUBJECTS: GIFT included 20 Veterans Affairs medical centers and 5678 subjects. MEASURES: Data regarding smoking status, delivery of treatment, medication use, and smoking cessation were collected from participant surveys, medical record review, survey of site leaders, and Pharmacy Benefits Management. RESULTS: The intervention did not increase participant report of being asked about smoking status or receipt of counseling. It did increase the rate of identification of smoking status in the medical record (P = 0.0001) but did not increase the rate of counseling to stop smoking. Site level data showed no increase in the number of patients receiving smoking cessation medications or dollars spent on medications. Individual smoker data showed a significant increase in the use of medications for smoking cessation in intervention sites (odds ratio = 6.89, P < 0.0001); however, only a small minority of smokers received medication even after the intervention. There was no difference in smoking cessation rates between participants at the intervention and treatment sites. CONCLUSIONS: We conclude that improvements in smoking cessation rates are likely to require more intensive intervention in this population. SN - 0025-7079 UR - https://www.unboundmedicine.com/medline/citation/15586837/Results_of_a_randomized_controlled_trial_of_intervention_to_implement_smoking_guidelines_in_Veterans_Affairs_medical_centers:_increased_use_of_medications_without_cessation_benefit_ L2 - https://doi.org/10.1097/00005650-200411000-00009 DB - PRIME DP - Unbound Medicine ER -