Maloney Connor J, Kurtz Jodi, Heim Megan K, Maloney James D, Taylor Lauren J
Department of Surgery, William S. Middleton Memorial Veterans Hospital, Madison, United States.
Pharmacy Section, William S. Middleton Memorial Veterans Hospital, Madison, United States.
Tob Prev Cessat. 2021 Jan 11;7:3. doi: 10.18332/tpc/130776. eCollection 2021.
Tobacco use remains pervasive amongst veterans. Unfortunately, the negative impact on postoperative outcomes may preclude surgeons from offering operative intervention to veterans who smoke. As such, a major health event may provide added incentive to quit. We sought to describe the role of acute illness and interventional specialist involvement in Veterans Affairs Smoking Cessation Program referrals compared to primary care wellness initiatives.
We retrospectively reviewed consultations to the pharmacy-led Smoking Cessation Program (SCP) at the Middleton Memorial VA Hospital from 2017 to 2019. Consultations placed during the last three months were categorized based on the source of referral: primary care, acute care, and interventional specialties. Descriptive statistics were used to assess rates of veteran engagement based on referral source. Consultation completion was used as a proxy for veteran engagement.
A total of 2993 new SCP consultations were placed during the study period. Overall, veteran engagement rose from 43% in 2017 to 53% in 2019. In recent months, there were 282 SCP referrals. While only 19 (7%) of these referrals were placed by interventional specialties - primarily cardiology and thoracic surgery - the rate of veteran engagement was 63%. The majority of referrals (65%) were placed by primary care providers with an engagement rate of 68%. In contrast, only 42% of consultations placed in the context of an acute illness were completed.
In our study, primary care directed smoking cessation referrals were most prevalent and resulted in the highest completion rates. The presence of an acute illness in isolation failed to impact program success. However, while surgeon-initiated referrals were meager in number, the engagement rate approached that of primary care. This finding suggests that surgeons play a powerful role in influencing patient behavior that may be harnessed to augment success of existing smoking cessation programs.
吸烟在退伍军人中仍然很普遍。不幸的是，吸烟对术后结果的负面影响可能使外科医生无法为吸烟的退伍军人提供手术干预。因此，重大健康事件可能会增加戒烟的动力。我们试图描述与初级保健健康倡议相比，急性疾病和介入专科医生参与退伍军人事务戒烟计划转诊的作用。
我们回顾性分析了2017年至2019年在米德尔顿纪念退伍军人医院由药房主导的戒烟计划（SCP）的咨询情况。将过去三个月内的咨询按照转诊来源进行分类：初级保健、急性护理和介入专科。使用描述性统计来评估基于转诊来源的退伍军人参与率。咨询完成情况被用作退伍军人参与的替代指标。
在研究期间共进行了2993次新的SCP咨询。总体而言，退伍军人的参与率从2017年的43%上升到2019年的53%。最近几个月，有282次SCP转诊。虽然这些转诊中只有19次（7%）是由介入专科医生提出的——主要是心脏病学和胸外科——但退伍军人的参与率为63%。大多数转诊（65%）是由初级保健提供者提出的，参与率为68%。相比之下，在急性疾病背景下进行的咨询中只有42%完成。
在我们的研究中，由初级保健主导的戒烟转诊最为普遍，且完成率最高。单纯的急性疾病并未影响项目的成功率。然而，虽然外科医生发起的转诊数量很少，但其参与率接近初级保健的水平。这一发现表明，外科医生在影响患者行为方面发挥着重要作用，可利用这一点来提高现有戒烟项目的成功率。
