Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration

Abstract

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.

Changes in Tobacco Use Patterns among Veterans in San Diego during the Recent Peak of the COVID-19 Pandemic

“…Previous research has shown the importance of active solicitation of information [68] and EMRs are now being used to help evaluate the effectiveness [69] and potential side effects [70,71] of COVID-19 vaccines. Similarly, EMR-based data has been utilized previously in studies looking at the effects of the COVID-19 pandemic as a stressor on people with bipolar disorder [72], the safety of the COVID-19 vaccine in pregnant women [73], the effect of COVID-19 on pregnancy outcomes [74], the effects of clinical characteristics on outcomes of COVID-19 patients [75][76][77], the factors that influence pharmacotherapy for tobacco dependence in the VA system [78], the effect of mental health disorders on COVID-19 mortality [79], COVID-19 vaccine adverse effects [68], and the effects of the COVID-19 pandemic on body mass index in children [80]. Thus, the present study builds upon a growing body of research examining similar effects of the COVID-19 pandemic.…”