Hamlett-Berry Kim, Davison John, Kivlahan Daniel R, Matthews Marybeth H, Hendrickson Jane E, Almenoff Peter L
Public Health Strategic Health Care Group, Veterans Health Administration, 810 Vermont Ave. NW, Washington, DC 20420, USA.
Mil Med. 2009 Jan;174(1):29-34. doi: 10.7205/milmed-d-00-3108.
Historically, the prevalence of smoking and smoking-related illnesses has been higher among veteran patients in the Veterans Health Administration (VHA) in comparison to that of the general population. Although rates of tobacco use have remained high, smoking cessation interventions continued to be greatly underutilized in VHA clinical settings just as they have been nationally. To address tobacco use as a public health priority, VHA has implemented a number of evidence-based national initiatives in recent years. This paper describes these initiatives, including: adoption of a population-health approach to smoking cessation; increased access to nicotine replacement therapy and/or smoking cessation medications; elimination of outpatient copayments for smoking cessation counseling; clinical practice guidelines; and collaboration with mental health and substance use disorder health care providers to promote integration of smoking cessation into routine treatment of psychiatric populations. The context of tobacco use among the newest veteran populations is also discussed, as well as recent efforts to evaluate the current state of smoking cessation care in VHA.
从历史上看，与普通人群相比，退伍军人健康管理局（VHA）中退伍军人患者的吸烟率及与吸烟相关疾病的患病率一直更高。尽管烟草使用率一直居高不下，但正如全国范围内的情况一样，VHA临床环境中戒烟干预措施的利用率仍然极低。为了将烟草使用作为公共卫生重点加以解决，VHA近年来实施了一些基于证据的全国性举措。本文介绍了这些举措，包括：采用人群健康方法进行戒烟；增加获得尼古丁替代疗法和/或戒烟药物的机会；取消戒烟咨询的门诊自付费用；临床实践指南；以及与心理健康和物质使用障碍医疗服务提供者合作，以促进将戒烟纳入精神疾病人群的常规治疗。还讨论了最新退伍军人人群中的烟草使用情况，以及近期评估VHA戒烟护理现状的努力。
