Veterans Integrated Service Network (VISN) 11 Tobacco Tactics Team: Implementation of the Tobacco Tactics Program in the Department of Veterans Affairs

Ann Arbor VA Center for Clinical Management Research, 2215 Fuller Rd., Ann Arbor, MI 48105, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 01/2010; 25 Suppl 1(S1):3-10. DOI: 10.1007/s11606-009-1075-9
Source: PubMed


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.
The objective of this paper is to describe the implementation of the Tobacco Tactics program for inpatients in the VA.
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.
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).
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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Available from: Sonia A Duffy
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    • "Over the last 12 years, our team has developed, tested, and refined the efficacious, nurse-administered Tobacco Tactics intervention in multiple populations including head and neck cancer patients [4], veterans [5], and Operating Engineers (ongoing research). In a recent Veterans Affairs (VA) Service Directed Project [5], our team packaged the Tobacco Tactics intervention into a toolkit and trained 573 inpatient nurses and ancillary personnel in two VA hospitals. "
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    ABSTRACT: BACKGROUND: The objectives of this smoking cessation study among hospitalized smokers are to: 1) determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys; 2) compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus usual care across hospitals, units, and patient characteristics using 30-day point prevalence abstinence at 30 days, 6-months (primary outcome), and 1 year after entry into the study; and 3) determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention relative to usual care including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. METHODS: This effectiveness study will be a quasi-experimental design of 6 Michigan community hospitals of which 3 will get the nurse-administered Tobacco Tactics intervention and 3 will provide their usual care. In both the intervention and usual care sites, research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at 30-days, 6-months, and 1-year post discharge. The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site. The Master Trainers, in turn, will teach the intervention to all staff nurses. Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination. Descriptive statistics will be used to summarize the results of surveys administered to nurses, nurses' participation rates, smokers' receipt of specific cessation services, and satisfaction with services. General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with adjustment for the clustering of patients within hospital units. Regression analyses will test the moderation of the effects of the interventions by patient characteristics. Cost-effectiveness will be assessed by constructing 3 ratios including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. DISCUSSION: Given that nurses represent the largest group of front-line providers, this intervention, if proven effective, has the potential for having a wide reach and thus decrease smoking, morbidity and mortality among inpatient smokers.
    Full-text · Article · Aug 2012 · Trials
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    • "While the VA has done a great deal to address smoking among veterans including outpatient groups, electronic medical record reminders, and easy access to cessation medications, little has been done to develop a unified strategy to address inpatient smoking across VA hospitals. In 2006 in Veterans Integrated Service Network 11, the Tobacco Tactics program was implemented and evaluated at two large Midwestern VA hospitals using a third hospital as a control [3]. Tobacco Tactics is a nurse-based inpatient smoking cessation program that includes brief physician advice, bedside nurse counseling, a patient smoking cessation video and workbook, pharmaceutical management, and follow-up telephone calls by hospital volunteers. "
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    ABSTRACT: The purpose of this study was to describe the development and evaluation of the image-based Veterans Affairs (VA) Tobacco Tactics program logo and campaign character using principles of social marketing. Four cross-sectional surveys with open- and closed-ended questions were used to gather participant demographic information, smoking behavior, and feedback on the development and evaluation of the Tobacco Tactics program logo and campaign character. The first 3 surveys were conducted with 229 veterans, visitors, and staff to obtain feedback for the final logo and character choice. The fourth survey was conducted with 47 inpatient veteran smokers to evaluate the Tobacco Tactics manual which was illustrated with the logo and campaign character. Descriptive statistics and bivariate analyses comparing demographic characteristics and tobacco use variables to opinions about the pictures for each round of testing were computed. After three rounds of testing to modify the logo and character choices based on participant feedback and survey data, the bulldog logo was chosen to represent the VA Tobacco Tactics program as it was viewed as strong and tough by the majority of participants. About 80% of the participants rated the manual highly on items such as logo, color, and pictures/illustrations. Almost 90% said they would recommend the manual to someone trying to quit smoking. Social marketing techniques that include consumer feedback to develop appealing tobacco cessation campaigns can increase consumer engagement and enhance the development of compelling tobacco cessation campaigns to compete with the influential marketing of tobacco companies.
    Full-text · Article · Apr 2012 · Tobacco Induced Diseases

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