VA Center for Clinical Management and Research, Department of Veterans Affairs Healthcare System, Ann Arbor, MI.
Department of Psychiatry, University of Michigan, Ann Arbor, MI.
Nicotine Tob Res. 2018 Sep 4;20(10):1173-1181. doi: 10.1093/ntr/ntx229.
There is evidence suggesting that certain subgroups of people who use tobacco do not receive tobacco pharmacology as consistently as others.
This retrospective, cohort study examined the trend in the use of cessation pharmacotherapy from 2004 to 2013 using Veterans Health Administration (VHA) administrative data. Among Veterans who used tobacco in the fiscal year (FY) 2011 and had not received pharmacotherapy in the prior year, multivariable Cox regression was used to assess the independent associations between patient clinical and demographic characteristics and pharmacotherapy initiation in the 6-months follow-up period.
Smoking cessation pharmacotherapy in the VHA increased from 13.8% in 2004 to 25.6% in 2013. In 2011, Veterans (N = 838309) who were more likely to newly receive pharmacotherapy included those with psychiatric disorders (depression, bipolar disorder, non-alcohol substance use disorder, other anxiety, and post-traumatic stress disorder), chronic pulmonary disease, peripheral vascular disorders, and younger Veterans (adjusted rate ratios (ARRs) ranged from 1.03 to 1.92, all p < .001). Veterans less likely to receive pharmacotherapy were those with schizophrenia or other psychosis, males, Hispanics, and those with a medical condition (uncomplicated diabetes, uncomplicated hypertension, fluid and electrolyte disorders, cardiac arrhythmia, valvular disease, hypothyroidism, acquired immunodeficiency syndrome/human immunodeficiency virus, deficiency anemia, renal failure, paralysis, coagulopathy, metastatic cancer, and other neurological disorders) (ARRs ranged from 0.74 to 0.93, all p < .001).
Although VHA cessation pharmacotherapy use nearly doubled from 13.8% in 2004 to 25.6% in 2013, reaching undertreated subgroups, especially those with medical comorbidities, may improve cessation outcomes.
Despite evidence that demographics influence the use of pharmacotherapy in smoking cessation, there is limited and contradictory information regarding how psychiatric and chronic medical illnesses affect pharmacotherapy use. Administrative data were used to determine trends and patient characteristics of those receiving pharmacotherapy to aid in smoking cessation in the Veterans Health Administration. From 2004 to 2013, pharmacotherapy use increased from 13.8% to 25.6% of current smokers. Factors associated with increased pharmacotherapy initiation were psychiatric disorders, chronic pulmonary disease, peripheral vascular disorders, and younger age. Veterans with schizophrenia or other psychosis, males, Hispanics, and most medical conditions were less likely to receive pharmacotherapy.
有证据表明，某些使用烟草的人群亚组并没有像其他人那样始终如一地接受烟草药理学。
这项回顾性队列研究使用退伍军人事务部（VA）行政数据，检查了 2004 年至 2013 年期间戒烟药理学治疗的使用趋势。在 2011 年财政年度（FY）使用烟草且在前一年未接受药理学治疗的退伍军人中，多变量 Cox 回归用于评估患者临床和人口统计学特征与 6 个月随访期间药理学治疗开始之间的独立关联。
VA 中的戒烟药理学治疗从 2004 年的 13.8%增加到 2013 年的 25.6%。2011 年，更有可能新接受药理学治疗的退伍军人包括那些患有精神疾病（抑郁症、双相情感障碍、非酒精物质使用障碍、其他焦虑症和创伤后应激障碍）、慢性肺部疾病、外周血管疾病和年轻的退伍军人（调整后的比率比（ARR）范围从 1.03 到 1.92，均<0.001）。不太可能接受药理学治疗的退伍军人包括患有精神分裂症或其他精神病、男性、西班牙裔以及患有某种疾病（单纯糖尿病、单纯高血压、液体和电解质紊乱、心律失常、瓣膜疾病、甲状腺功能减退症、获得性免疫缺陷综合征/人类免疫缺陷病毒、贫血、肾衰竭、瘫痪、凝血障碍、转移性癌症和其他神经障碍）的退伍军人（ARR 范围从 0.74 到 0.93，均<0.001）。
尽管 VA 戒烟药理学治疗的使用率从 2004 年的 13.8%几乎翻了一番，达到 2013 年的 25.6%，但仍有一些未得到充分治疗的亚组，特别是患有合并症的退伍军人，可能会改善戒烟效果。
尽管有证据表明人口统计学因素会影响戒烟中的药理学治疗使用，但关于精神和慢性疾病如何影响药理学治疗使用的信息有限且存在矛盾。行政数据用于确定接受药理学治疗的患者的趋势和特征，以帮助退伍军人事务部戒烟。从 2004 年到 2013 年，药理学治疗的使用率从当前吸烟者的 13.8%增加到 25.6%。与增加药理学治疗开始相关的因素是精神疾病、慢性肺部疾病、外周血管疾病和年轻年龄。患有精神分裂症或其他精神病、男性、西班牙裔以及大多数疾病的退伍军人不太可能接受药理学治疗。
