Jennifer A Lewis1,2,3, Nicole Senft4, Heidi Chen5,6, Kathryn E Weaver7, Lucy B Spalluto8,5,9, Kim L Sandler5,9, Leora Horn10,5, Pierre P Massion5,11,12, Robert S Dittus8,13, Christianne L Roumie8,13, Hilary A Tindle8,13. 1. Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA. jennifer.a.lewis@vumc.org. 2. Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37203, USA. jennifer.a.lewis@vumc.org. 3. Vanderbilt-Ingram Cancer Center, Nashville, TN, USA. jennifer.a.lewis@vumc.org. 4. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 5. Vanderbilt-Ingram Cancer Center, Nashville, TN, USA. 6. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. 7. Departments of Social Sciences and Health Policy and Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA. 8. Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA. 9. Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA. 10. Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37203, USA. 11. Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 12. Medicine Service, Veterans Health Administration-Tennessee Valley Healthcare System, Nashville, TN, USA. 13. Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.
Abstract
BACKGROUND: A systems-level approach to smoking cessation treatment may optimize healthcare provider adherence to guidelines. Institutions such as the Veterans Health Administration (VHA) are unique in their systematic approach, but comparisons of provider behavior in different healthcare systems are limited. METHODS: We surveyed general medicine providers and specialists in a large academic health center (AHC) and its affiliated VHA in the Mid-South in 2017 to determine the cross-sectional association of healthcare system in which the provider practiced (exposure: AHC versus VHA) with self-reported provision of evidence-based smoking cessation treatment (delivery of counseling plus smoking cessation medication or referral) at least once in the past 12 months (composite outcome). Multivariable logistic regression with adjustment for specialty was performed in 2017-2019. RESULTS: Of 625 healthcare providers surveyed, 407 (65%) responded, and 366 (59%) were analyzed. Most respondents practiced at the AHC (273[75%] vs VHA 93[25%]) and were general internists (215[59%]); pulmonologists (39[11%]); hematologists/oncologists (69[19%]); and gynecologists (43[12%]). Most respondents (328[90%]) reported the primary outcome. The adjusted odds of evidence-based smoking cessation treatment were higher among VHA vs. AHC healthcare providers (aOR = 4.3; 95% CI 1.3-14.4; p = .02). Health systems differed by provision of individual treatment components, including smoking cessation medication use (98% VHA vs. 90% AHC, p = 0.02) and referral to smoking cessation services (91% VHA vs. 65% AHC p = 0.001). CONCLUSIONS: VHA healthcare providers were significantly more likely to provide evidence-based smoking cessation treatment compared to AHC healthcare providers. Healthcare systems' prioritization of and investment in smoking cessation treatment is critical to improving providers' adherence to guidelines.
BACKGROUND: A systems-level approach to smoking cessation treatment may optimize healthcare provider adherence to guidelines. Institutions such as the Veterans Health Administration (VHA) are unique in their systematic approach, but comparisons of provider behavior in different healthcare systems are limited. METHODS: We surveyed general medicine providers and specialists in a large academic health center (AHC) and its affiliated VHA in the Mid-South in 2017 to determine the cross-sectional association of healthcare system in which the provider practiced (exposure: AHC versus VHA) with self-reported provision of evidence-based smoking cessation treatment (delivery of counseling plus smoking cessation medication or referral) at least once in the past 12 months (composite outcome). Multivariable logistic regression with adjustment for specialty was performed in 2017-2019. RESULTS: Of 625 healthcare providers surveyed, 407 (65%) responded, and 366 (59%) were analyzed. Most respondents practiced at the AHC (273[75%] vs VHA 93[25%]) and were general internists (215[59%]); pulmonologists (39[11%]); hematologists/oncologists (69[19%]); and gynecologists (43[12%]). Most respondents (328[90%]) reported the primary outcome. The adjusted odds of evidence-based smoking cessation treatment were higher among VHA vs. AHC healthcare providers (aOR = 4.3; 95% CI 1.3-14.4; p = .02). Health systems differed by provision of individual treatment components, including smoking cessation medication use (98% VHA vs. 90% AHC, p = 0.02) and referral to smoking cessation services (91% VHA vs. 65% AHC p = 0.001). CONCLUSIONS: VHA healthcare providers were significantly more likely to provide evidence-based smoking cessation treatment compared to AHC healthcare providers. Healthcare systems' prioritization of and investment in smoking cessation treatment is critical to improving providers' adherence to guidelines.
Authors: Hilary A Tindle; Robin Daigh; Vivek K Reddy; Linda A Bailey; Judy A Ochs; Marty H Maness; Esa M Davis; Anna E Schulze; Kristi M Powers; Thomas E Ylioja; Hilary B Baca; Jay L Mast; Matthew S Freiberg Journal: Am J Prev Med Date: 2016-07-29 Impact factor: 5.043
Authors: Andrew S Nickels; David O Warner; Sarah Michelle Jenkins; Jon Tilburt; J Taylor Hays Journal: Nicotine Tob Res Date: 2016-08-24 Impact factor: 4.244
Authors: Nicole Senft; Maureen Sanderson; Rebecca Selove; William J Blot; Stephen King; Karen Gilliam; Suman Kundu; Mark Steinwandel; Sarah J Sternlieb; Shaneda Warren Andersen; Debra L Friedman; Erin Connors; Mary Kay Fadden; Matthew Freiberg; Quinn S Wells; Juan Canedo; Rachel F Tyndale; Robert P Young; Raewyn J Hopkins; Hilary A Tindle Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-06-03 Impact factor: 4.254
Authors: Michael Fiore; Rob Adsit; Mark Zehner; Danielle McCarthy; Susan Lundsten; Paul Hartlaub; Todd Mahr; Allison Gorrilla; Amy Skora; Timothy Baker Journal: J Am Med Inform Assoc Date: 2019-08-01 Impact factor: 4.497
Authors: Molly B Conroy; Nicola E Majchrzak; Caroline B Silverman; Yuchiao Chang; Susan Regan; Louise I Schneider; Nancy A Rigotti Journal: Nicotine Tob Res Date: 2005-04 Impact factor: 4.244
Authors: Quinn S Wells; Matthew S Freiberg; Robert A Greevy; Rachel F Tyndale; Suman Kundu; Meredith S Duncan; Stephen King; Lesa Abney; Elizabeth Scoville; Dawn B Beaulieu; Vanessa Gatskie; Hilary A Tindle Journal: Nicotine Tob Res Date: 2018-11-15 Impact factor: 4.244