Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration
Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration
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DOI：
10.1007/s11606-021-07011-0
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发表时间：
2021-07-19
影响因子：
5.7
通讯作者：
Zeliadt, Steven B.
中科院分区：
文献类型：
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作者：
Heffner, Jaimee L.;Coggeshall, Scott;Zeliadt, Steven B.
背景：在肺癌筛查中实施有效的戒烟干预措施已被确定为一个高优先级的研究缺口，但由于筛查的吸收缓慢，以及缺乏在现实条件下评估戒烟相关实践和结果的数据，目前指导过程改进的实践知识有限。目的评估美国最大的综合医疗保健系统——退伍军人健康管理局（VHA）戒烟治疗的接受情况和筛查后1年的戒烟结果。设计观察性研究，使用来自电子医疗记录（EMR）的管理数据。在2014年1月至2018年6月期间首次使用低剂量CT （LDCT）进行肺癌筛查的吸烟退伍军人患者。在LDCT前后30天窗口内接受烟草治疗；基于EMR吸烟健康因素数据的1年戒烟率在LDCT后6-18个月。在筛查的47609名当前吸烟者中（95.3%为男性），8702名（18.3%）接受了药物治疗和/或行为戒烟治疗；531人（1.1%）两者都接受。在接受药物治疗的患者中，只有四分之一的人接受了最有效的药物之一：伐尼克兰（12.1%）或联合尼古丁替代疗法（14.3%）。总体而言，5400名退伍军人戒烟，比例为11.3%（失踪=吸烟）或13.5%（完整的案例分析）。接受和停止治疗与许多社会人口学、临床和筛查相关因素有关。结论：VHA中接受肺癌筛查的退伍军人一年戒烟率与LDCT临床试验和队列研究中报道的相似（即10-17%）。只有1%的退伍军人接受了推荐的药物治疗和咨询的组合，最有效的药物治疗并不是最常见的药物治疗。通过解决这些治疗差距，以及根据种族、农村和精神状况观察到的接受或停止治疗的差异，可以提高VHA内筛查的价值。
Background Implementation of effective smoking cessation interventions in lung cancer screening has been identified as a high-priority research gap, but knowledge of current practices to guide process improvement is limited due to the slow uptake of screening and dearth of data to assess cessation-related practices and outcomes under real-world conditions. Objective To evaluate cessation treatment receipt and 1-year post-screening cessation outcomes within the largest integrated healthcare system in the USA-the Veterans Health Administration (VHA). Design Observational study using administrative data from electronic medical records (EMR). Patients Currently smoking Veterans who received a first lung cancer screening test using low-dose CT (LDCT) between January 2014 and June 2018. Main Outcomes Tobacco treatment received within the window of 30 days before and 30 days after LDCT; 1-year quit rates based on EMR Smoking Health Factors data 6-18 months after LDCT. Key Results Of the 47,609 current smokers screened (95.3% male), 8702 (18.3%) received pharmacotherapy and/or behavioral treatment for smoking cessation; 531 (1.1%) received both. Of those receiving pharmacotherapy, only one in four received one of the most effective medications: varenicline (12.1%) or combination nicotine replacement therapy (14.3%). Overall, 5400 Veterans quit smoking-a rate of 11.3% (missing=smoking) or 13.5% (complete case analysis). Treatment receipt and cessation were associated with numerous sociodemographic, clinical, and screening-related factors. Conclusions One-year quit rates for Veterans receiving lung cancer screening in VHA are similar to those reported in LDCT clinical trials and cohort studies (i.e., 10-17%). Only 1% of Veterans received the recommended combination of pharmacotherapy and counseling, and the most effective pharmacotherapies were not the most commonly received ones. The value of screening within VHA could be improved by addressing these treatment gaps, as well as the observed disparities in treatment receipt or cessation by race, rurality, and psychiatric conditions.