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IMPACT OF A DROP-IN GROUP MEDICAL APPOINTMENT ON TOBACCO QUIT RATES

The tobacco quit rate of veterans on pharmacotherapy who attended at least 1
drop-in group session was higher than the quit rate of veterans only on
pharmacotherapy.
Federal Practitioner. 2016 August;33(8):18-21
August 12, 2016|Federal Practitioner

Jessica L. Harris, PharmD;Steffanie M. Danley, PharmD, BCPS, CACP;Tarryn Jansen,
PharmD;Kelley J. Oehlke, BCACP
Author and Disclosure Information
✕

Dr. Harris was a PGY-1 pharmacy resident at the time the article was written,
Drs. Danley and Jansen are ambulatory care clinical pharmacy specialists, and
Dr. Oehlke was an ambulatory care clinical pharmacy specialist and residency
program director at the time the article was written, all at Sioux Falls VA
Health Care System in South Dakota. Dr. Jansen also is an assistant professor of
pharmacy practice at South Dakota State University College of Pharmacy in
Brookings.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to
this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily
reflect those of Federal Practitioner, Frontline Medical Communications Inc.,
the U.S. Government, or any of its agencies. This article may discuss unlabeled
or investigational use of certain drugs. Please review the complete prescribing
information for specific drugs or drug combinations—including indications,
contraindications, warnings, and adverse effects—before administering
pharmacologic therapy to patients.



Every year in the U.S., more than 435,000 people die of illnesses related to
tobacco use.1 The CDC reported that from 2012 to 2013, 21.3% of adults used some
form of tobacco daily or on some days.2 Veterans are not excluded from these
numbers: A 2005 survey found 22.2% of VA patients were current smokers, and
71.2% of VA patients had smoked at least 100 cigarettes in their life.3

Military personnel have a higher propensity to be in situations that increase
the risk of tobacco use than the general population does.3,4 These situations
include alternating between periods of high stress and boredom, separation from
loved ones, perceived camaraderie involved with tobacco use, and the limitation
of healthier coping mechanisms.3,4 Stress and boredom have been cited as the top
reasons for initiating tobacco use when deployed.3,4 Furthermore, once military
personnel return from deployment, they may have difficulty quitting tobacco due
to depression, sleeplessness, change in the structure of everyday life, or a
second deployment.4

In 2009 Bondurant and Wedge predicted that the VA would spend $30.9 billion in
preventable smoking-related expenditures by 2024.3 The negative health effects
and the financial impact of tobacco make cessation programs an important
investment for the VA.



In 2012, the CDC reported that 70% of veterans want to quit tobacco; therefore,
veterans likely would be interested in tobacco cessation programs.4 Reasons
veterans noted for quitting included family, changes in the social norm, better
overall health, and better ability to breathe.4 Veterans also identified that
tobacco cessation programs with convenience, personalization, reduced-cost
medications, and peer support would be most helpful.4

According to a 2008 tobacco use and dependence guideline update, the most
effective therapy for quitting tobacco is counseling plus pharmacotherapy.1
According to the guideline, the number of counseling sessions combined with
pharmacotherapy is strongly related to the likelihood of quitting.1 A number of
studies also have shown that telephone counseling is effective for tobacco
cessation.5 However, a previous study in veterans found that scheduled
face-to-face counseling sessions may be more effective than telephone
counseling.6 Dent and colleagues found a statistically significant quit rate at
6 months of 28% in the face-to-face group vs 11.8% in the telephone group.6

After reviewing the guidelines, analyzing the studies, and learning what
veterans find most helpful in tobacco cessation programs, the Sioux Falls VA
Health Care System (SFVAHCS) in South Dakota took a unique approach to tobacco
cessation. In 2012, SFVAHCS implemented a tobacco cessation drop-in group
medical appointment (DIGMA) to improve tobacco quit rates. The DIGMA is a
1-hour, educational supportive clinic that allows veterans to drop in during any
class anytime, regardless of their tobacco use status. This clinic mostly serves
outpatients; however, inpatients also are welcome. Patients are informed of the
DIGMA by a health care provider (HCP) or patient information flyers posted
throughout SFVAHCS.

The DIGMA takes place once a week in a classroom next to a primary care waiting
area, making it easily accessible. During the DIGMA, an HCP, such as a nurse or
physician, provides behavioral education. VA materials (Primary Care and Tobacco
Cessation Handbook and My Tobacco Cessation Workbook designed by Julianne
Himstreet, PharmD, BCPS) are used to guide classes.7,8 These books address
barriers to quitting, coping with nicotine withdrawal, planning for quit day,
handling tobacco cravings, watching out for triggers, and staying tobacco
free.7,8 Clinical pharmacists also are present at the DIGMA for patients who
want to start or continue pharmacotherapy. The pharmacists can prescribe tobacco
cessation medications and follow up on the success or adverse effects (AEs) of
therapy.

The purpose of this study was to examine how a voluntary, drop-in, face-to-face
tobacco cessation clinic impacts tobacco quit rates in veterans receiving
pharmacotherapy.


METHODS

A retrospective chart review was performed for all study site outpatients
started on pharmacotherapy for tobacco cessation between September 1, 2012 and
August 31, 2013, as determined by pharmacy dispensing records. Two groups were
evaluated in this study: the pharmacotherapy-only (PO) group and the DIGMA
group. Pharmacotherapy was most often prescribed by an HCP in the PO group.
Other prescribers may have included pharmacists, mental health providers, and
hospitalists. The second group was the DIGMA group, which included patients who
were on tobacco cessation pharmacotherapy and attended at least 1 DIGMA class
within a year of starting pharmacotherapy.

For this study, pharmacotherapy included nicotine gum, nicotine lozenge,
nicotine patch, bupropion, varenicline, and any combination of these
medications. Patients were excluded if they died, moved, or were lost to
follow-up within 1 year of starting pharmacotherapy for a new quit attempt; were
not at the beginning of a quit attempt; or were taking bupropion for mood or
depression only.

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References
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