Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration
Introduction While initiation rates of tobacco cessation pharmacotherapy have improved both inside and outside the Department of Veteran Affairs (VA), prescribing rates remain low. The objective of this study was to examine correlation of the characteristics of providers, clinics, and facilities wit...
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doaj-1b5934555ec84ac1a3f805ed56ffff792021-09-06T07:14:51ZengEuropean PublishingTobacco Induced Diseases1617-96252021-08-0119August11110.18332/tid/140091140091Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health AdministrationAmanda C. Blok0Rosalinda V. Ignacio1Mark C. Geraci2Hyungjin Myra Kim3Paul G. Barnett4Sonia A. Duffy5VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United StatesDepartment of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, United StatesDepartment of Veterans Affairs Pharmacy Benefits Management Services, United States Department of Veterans Affairs, Hines, United StatesCenter for Statistical Consultation and Research, University of Michigan, Ann Arbor, United StatesHealth Economics Resource Center, United States Department of Veterans Affairs, Menlo Park, United StatesCollege of Nursing, The Ohio State University, Columbus, United StatesIntroduction While initiation rates of tobacco cessation pharmacotherapy have improved both inside and outside the Department of Veteran Affairs (VA), prescribing rates remain low. The objective of this study was to examine correlation of the characteristics of providers, clinics, and facilities with initiation of tobacco cessation pharmacotherapy. Methods This retrospective, observational study used VA outpatient electronic medical record data from federal fiscal year 2011. Logistic regression models estimated the adjusted odds ratio associated with provider characteristics for pharmacotherapy initiation. Results For the 639507 veterans who used tobacco, there were 30388 providers caring for them. Younger (p<0.001) and female (p<0.001) providers were more likely to initiate tobacco cessation pharmacotherapy. Compared to physicians, pharmacists were 74% more likely to initiate pharmacotherapy, while all groups of nurses were 5–8% and physicians’ assistants were 12% less likely (p<0.001). Compared to those seen in primary care clinics, patients assessed in substance use treatment clinics were 16% more likely to have pharmacotherapy initiated (p<0.001), while those in psychiatry were 10% less likely (p<0.001), and those in outpatient surgery were 39% less likely to initiate pharmacotherapy (p<0.001). Compared to almost all other classes of VA facilities, patients seen in primary care community-based outpatient clinics (CBOCs) were 7–28% more likely to initiate pharmacotherapy (p<0.0001). Conclusions While the VA is at the leading edge of providing tobacco cessation pharmacotherapy, targeting quality improvement efforts towards providers, clinics, and facilities with low prescribing rates will be essential to continue the declining rates of tobacco use among VA patients.http://www.tobaccoinduceddiseases.org/Provider-and-clinical-setting-characteristics-associated-with-ntobacco-pharmacotherapy,140091,0,2.htmlsmoking cessation agentstobacco use cessationdrug prescriptionshealth personnelhealth services |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Amanda C. Blok Rosalinda V. Ignacio Mark C. Geraci Hyungjin Myra Kim Paul G. Barnett Sonia A. Duffy |
spellingShingle |
Amanda C. Blok Rosalinda V. Ignacio Mark C. Geraci Hyungjin Myra Kim Paul G. Barnett Sonia A. Duffy Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration Tobacco Induced Diseases smoking cessation agents tobacco use cessation drug prescriptions health personnel health services |
author_facet |
Amanda C. Blok Rosalinda V. Ignacio Mark C. Geraci Hyungjin Myra Kim Paul G. Barnett Sonia A. Duffy |
author_sort |
Amanda C. Blok |
title |
Provider and clinical setting characteristics associated with
tobacco pharmacotherapy dispensed in the Veterans Health
Administration |
title_short |
Provider and clinical setting characteristics associated with
tobacco pharmacotherapy dispensed in the Veterans Health
Administration |
title_full |
Provider and clinical setting characteristics associated with
tobacco pharmacotherapy dispensed in the Veterans Health
Administration |
title_fullStr |
Provider and clinical setting characteristics associated with
tobacco pharmacotherapy dispensed in the Veterans Health
Administration |
title_full_unstemmed |
Provider and clinical setting characteristics associated with
tobacco pharmacotherapy dispensed in the Veterans Health
Administration |
title_sort |
provider and clinical setting characteristics associated with
tobacco pharmacotherapy dispensed in the veterans health
administration |
publisher |
European Publishing |
series |
Tobacco Induced Diseases |
issn |
1617-9625 |
publishDate |
2021-08-01 |
description |
Introduction
While initiation rates of tobacco cessation pharmacotherapy have
improved both inside and outside the Department of Veteran Affairs (VA),
prescribing rates remain low. The objective of this study was to examine
correlation of the characteristics of providers, clinics, and facilities with
initiation of tobacco cessation pharmacotherapy.
Methods
This retrospective, observational study used VA outpatient electronic
medical record data from federal fiscal year 2011. Logistic regression models
estimated the adjusted odds ratio associated with provider characteristics for
pharmacotherapy initiation.
Results
For the 639507 veterans who used tobacco, there were 30388 providers
caring for them. Younger (p<0.001) and female (p<0.001) providers were
more likely to initiate tobacco cessation pharmacotherapy. Compared to
physicians, pharmacists were 74% more likely to initiate pharmacotherapy,
while all groups of nurses were 5–8% and physicians’ assistants were 12%
less likely (p<0.001). Compared to those seen in primary care clinics, patients
assessed in substance use treatment clinics were 16% more likely to have
pharmacotherapy initiated (p<0.001), while those in psychiatry were 10%
less likely (p<0.001), and those in outpatient surgery were 39% less likely to
initiate pharmacotherapy (p<0.001). Compared to almost all other classes of
VA facilities, patients seen in primary care community-based outpatient clinics
(CBOCs) were 7–28% more likely to initiate pharmacotherapy (p<0.0001).
Conclusions
While the VA is at the leading edge of providing tobacco cessation
pharmacotherapy, targeting quality improvement efforts towards providers,
clinics, and facilities with low prescribing rates will be essential to continue
the declining rates of tobacco use among VA patients. |
topic |
smoking cessation agents tobacco use cessation drug prescriptions health personnel health services |
url |
http://www.tobaccoinduceddiseases.org/Provider-and-clinical-setting-characteristics-associated-with-ntobacco-pharmacotherapy,140091,0,2.html |
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