Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial

Abstract

PurposeTo examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers. DesignPre-post quasi-experimental trial. SettingGeneral medical units of four US Department of Veterans Affairs hospitals. Subjects898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively). InterventionThe intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback. MeasuresThe primary outcome was self-reported 7-day point prevalence abstinence at six months. AnalysisTobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression. ResultsSeven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio (AOR) and 95% confidence interval (CI95)=0.78 [0.51–1.18]) or six months (AOR=0.92; CI95=0.62–1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect (p=0.0004) and perceived likelihood of staying off cigarettes following discharge (p<0.0001). ConclusionsTobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.