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Implementation of the Tobacco Tactics Program in the Department of Veterans Affairs

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Abstract

BACKGROUND

Smoking cessation services in the Department of Veterans Affairs (VA) are currently provided via outpatient groups, while inpatient cessation programs have not been widely implemented.

OBJECTIVE

The objective of this paper is to describe the implementation of the Tobacco Tactics program for inpatients in the VA.

METHODS

This is a pre-/post-non-randomized control study initially designed to teach inpatient staff nurses on general medical units in the Ann Arbor and Detroit VAs to deliver the Tobacco Tactics intervention using Indianapolis as a control group. Coupled with cessation medication sign-off, physicians are reminded to give patients brief advice to quit.

RESULTS

Approximately 96% (210/219) of inpatient nurses in the Ann Arbor, MI site and 57% (159/279) in the Detroit, MI site have been trained, with an additional 282 non-targeted personnel spontaneously attending. Nurses’ self-reported administration of cessation services increased from 57% pre-training to 86% post-training (p = 0.0002). Physician advice to quit smoking ranged between 73–85% in both the pre-intervention and post-intervention period in both the experimental and control group. Volunteers made follow-up telephone calls to 85% (n = 230) of participants in the Ann Arbor site. Hospitalized smokers (N = 294) in the intervention group are reporting an increase in receiving and satisfaction with the selected cessation services following implementation of the program, particularly in regards to medications (p < 0.05).

CONCLUSION

A large proportion of inpatient nursing staff can rapidly be trained to deliver tobacco cessation interventions to inpatients resulting in increased provision of services.

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ACKNOWLEDGMENTS

First and foremost, the authors would like to express our heartfelt appreciation to the Ann Arbor and Detroit nurses and other staff who included the intervention in their already busy work schedules. In particular, we would like to thank the nurse champions that contributed to spear-heading Tobacco Tactics on their units, including Christine Bulifant, Yamil Casillas-Hernandez, Denise Crawford, Bryan Facione, Kelly Johnston, Patricia Lello, Bettie Martinez, Carey Michel, Sarah Palmateer, Melissa Powers, Ruth Riley, Mary Jane Roth, Diane Sobecki-Ryniak, Cecilia Sosnowski, Patricia Teague, Arik Theeke, Sylvia Wallace, Charles Washington, Vicki Washington, Lori Wilson, and Patrick Wozny. Special thanks go to Ann Arbor VA volunteers Edward Florence and Thomas Griffiths for providing the follow-up phone calls to nearly 270 patients. Moreover, we would like to acknowledge the administrative staff who supported the integration of the Tobacco Tactics program into the organization, including, but not limited to, Pamela Reeves, Christopher Hermann, Stacey Breedveld, Micki Wheaton, Pamela McCoy, Linda Seck, Suzanne Mohler, Patricia Gurley, Barbara Clarke, Thomas Heller, Cindy Shepler, Diane Jamrog, and Beverly Leneski. Special thanks go to Rodney Hayward, Sarah Krein, and Laura Damschroder for their editorial comments. Most importantly, we would like to thank the veterans that participated in this study. Lastly, we would like to thank the Department of Veterans Affairs for their generous support of this Service Directed Project (SDP 06–003).

Conflict of interest

None disclosed.

Author information

Authors and Affiliations

  1. Ann Arbor VA Center for Clinical Management Research (11H), 2215 Fuller Rd., Ann Arbor, MI, 48105, USA

    Sonia A. Duffy PhD, RN, Carrie A. Karvonen-Gutierrez MPH & Lee A. Ewing MPH

  2. School of Nursing, Departments of Otolaryngology and Psychiatry, , University of Michigan, Ann Arbor, MI, USA

    Sonia A. Duffy PhD, RN

  3. Northern Ontario School of Medicine, Human Sciences Division, Thunder Bay, ON, Canada

    Patricia M. Smith PhD

Authors
  1. Sonia A. Duffy PhD, RN
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  2. Carrie A. Karvonen-Gutierrez MPH
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  3. Lee A. Ewing MPH
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  4. Patricia M. Smith PhD
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Consortia

Veterans Integrated Services Network (VISN) 11 Tobacco Tactics Team

Corresponding author

Correspondence to Sonia A. Duffy PhD, RN.

Additional information

The members of the VISN 11 Tobacco Tactics Team in alphabetical order are Timothy Carmody, Carmelite Dalmacy, Petra Flanagan, Amanda Fore, Judy Heath, Thomas Hicks, David Ronis, and Richard White

Appendix

Appendix

Appendix A. Smoking Cessation Behavioral Management Protocol

  1. 1.

    Assess if patient is interested in quitting.

  2. 2.

    If patient is not interested, leave a brochure at bedside.

  3. 3.

    If patient is interested, leave a brochure and arrange for patient to view videotape.

  4. 4.

    After videotape, provide patient with Tobacco Tactics manual to read if able.

  5. 5.

    Using patient manual, assist patient with behavioral intervention including:

    1. a.

      Self assessment

    2. b.

      Smoker type

    3. c.

      Smoking costs

    4. d.

      Handling cravings

    5. e.

      Relapse prevention

    6. f.

      Medication options

  6. 6.

    Along with patient, identify and arrange for cessation medications (see pharmaceutical protocol).

  7. 7.

    Arrange for volunteer follow-up calls.

Appendix B. Smoking Cessation Pharmaceutical Management Protocol

  1. 1.

    Recommend nicotine replacement (patch, gum, or lozenge) if:

    1. a.

      Never used patch, gum, or lozenge before.

    2. b.

      Used patch, gum, or lozenge successfully in the past (smoke-free >3 months).

  2. 2.

    Recommend Bupropion if:

    1. a.

      Failed nicotine replacement monotherapy in the past (smoke-free <3 months).

    2. b.

      Patch, gum, or lozenge intolerant (i.e., rash, etc.).

    3. c.

      History of depression or currently has depressive symptoms.

  3. 3.

    Recommend combination nicotine replacement (patch, gum, or lozenge) and Bupropion if:

    1. a.

      Failed nicotine replacement and Bupropion monotherapy in the past.

  4. 4.

    Recommend Varenicline if:

    1. a.

      Intolerance or treatment failure to nicotine replacement and bupropion.

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Duffy, S.A., Karvonen-Gutierrez, C.A., Ewing, L.A. et al. Implementation of the Tobacco Tactics Program in the Department of Veterans Affairs. J GEN INTERN MED 25 (Suppl 1), 3–10 (2010). https://doi.org/10.1007/s11606-009-1075-9

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  • DOI: https://doi.org/10.1007/s11606-009-1075-9

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