Proactive Outreach for Smokers in VA Mental Health
| Status: | Completed |
|---|---|
| Conditions: | Smoking Cessation |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/28/2019 |
| Start Date: | July 1, 2014 |
| End Date: | June 30, 2018 |
Veterans with a mental health diagnosis have higher a prevalence of smoking and higher rates
of smoking-related morbidities compared to the general Veteran population. Smoking cessation
treatment delivery in the VA typically depends on a visit from a health care provider. In
this study, investigators will use information within the electronic medical record to
identify all smokers with a mental health diagnosis at a VA health care facility and
proactively reach out to enroll them in an intensive tobacco cessation treatment program.
This approach could be generalized to other behaviors and provides a novel method to improve
the health of an entire population of patients.
of smoking-related morbidities compared to the general Veteran population. Smoking cessation
treatment delivery in the VA typically depends on a visit from a health care provider. In
this study, investigators will use information within the electronic medical record to
identify all smokers with a mental health diagnosis at a VA health care facility and
proactively reach out to enroll them in an intensive tobacco cessation treatment program.
This approach could be generalized to other behaviors and provides a novel method to improve
the health of an entire population of patients.
Background:
Tobacco use is the leading preventable cause of death in the United States and contributes up
to 24% of all VA healthcare costs. Veterans enrolled in the VA healthcare system smoke
substantially more than the general population, which is particularly true among Veterans
diagnosed with mental illness. Patients with bipolar disorder or schizophrenia have the
highest smoking rates (69% and 58-90%, respectively) followed by those with PTSD (45-63%) and
depression (31-51%). Numerous barriers exist for tobacco cessation among mental health
patients, including high nicotine dependency, low rates of follow through for referrals, and
limited availability of tobacco treatment tailored to their needs.
Rationale:
Most medical care providers assess tobacco use and advise smokers to quit, but they have
insufficient time to follow up with treatment, leading to low long-term quit rates. Mental
health providers who often meet regularly with patients report that they find tobacco
cessation outside the scope of their practice and neither assess tobacco use nor refer
smokers for treatment. These practice patterns have been very difficult to change even with
intensive methods and across various settings and provider types. Therefore, the
investigators here propose to use the electronic medical record system to identify smokers
receiving mental health care and proactively reach out to engage them in treatment in line
with the following aims:
Specific Aims:
1. Compare the reach and efficacy of a proactive outreach telephone-based tobacco cessation
(PRO) program for patients seen in mental health to usual care (UC) advice and referral
to local VA and community tobacco cessation resources.
2. Model longitudinal associations between baseline sociodemographic, medical and mental
health characteristics and abstinence at 6 and 12 months in the PRO and UC conditions.
Methods:
Investigators will use the electronic medical record to identify N=6,400 patients across 4 VA
healthcare facilities who have a clinical reminder code indicating current tobacco use in the
past year and who have had a mental health visit in the past 6 months. Investigators will
send each patient an introductory letter and baseline survey. Respondents will be randomized
in a 1:1 fashion to intervention or control. Control participants will receive VA usual care.
Intervention participants will receive proactive telephone counseling and cessation
medications. Investigators will assess tobacco use at 6 and 12 months from enrollment. The
primary outcome is cotinine-validated abstinence at the 12-month follow-up.
Tobacco use is the leading preventable cause of death in the United States and contributes up
to 24% of all VA healthcare costs. Veterans enrolled in the VA healthcare system smoke
substantially more than the general population, which is particularly true among Veterans
diagnosed with mental illness. Patients with bipolar disorder or schizophrenia have the
highest smoking rates (69% and 58-90%, respectively) followed by those with PTSD (45-63%) and
depression (31-51%). Numerous barriers exist for tobacco cessation among mental health
patients, including high nicotine dependency, low rates of follow through for referrals, and
limited availability of tobacco treatment tailored to their needs.
Rationale:
Most medical care providers assess tobacco use and advise smokers to quit, but they have
insufficient time to follow up with treatment, leading to low long-term quit rates. Mental
health providers who often meet regularly with patients report that they find tobacco
cessation outside the scope of their practice and neither assess tobacco use nor refer
smokers for treatment. These practice patterns have been very difficult to change even with
intensive methods and across various settings and provider types. Therefore, the
investigators here propose to use the electronic medical record system to identify smokers
receiving mental health care and proactively reach out to engage them in treatment in line
with the following aims:
Specific Aims:
1. Compare the reach and efficacy of a proactive outreach telephone-based tobacco cessation
(PRO) program for patients seen in mental health to usual care (UC) advice and referral
to local VA and community tobacco cessation resources.
2. Model longitudinal associations between baseline sociodemographic, medical and mental
health characteristics and abstinence at 6 and 12 months in the PRO and UC conditions.
Methods:
Investigators will use the electronic medical record to identify N=6,400 patients across 4 VA
healthcare facilities who have a clinical reminder code indicating current tobacco use in the
past year and who have had a mental health visit in the past 6 months. Investigators will
send each patient an introductory letter and baseline survey. Respondents will be randomized
in a 1:1 fashion to intervention or control. Control participants will receive VA usual care.
Intervention participants will receive proactive telephone counseling and cessation
medications. Investigators will assess tobacco use at 6 and 12 months from enrollment. The
primary outcome is cotinine-validated abstinence at the 12-month follow-up.
Inclusion Criteria:
- Current smoker (i.e., any tobacco use in past 30 days)
- Seen in VA Mental Health Clinic in prior 12 months
Exclusion Criteria:
- Dementia
- Does not speak English
- Does not have a telephone and mailing address (necessary to mail out consent materials
and to deliver the telephone-based intervention)
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