| Summary: | Introduction
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.
Methods
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.
Results
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.
Conclusions
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.
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