BACKGROUND: Many smokers admitted for chronic obstructive pulmonary disease (COPD) are not given smoking cessation medications at discharge. The reasons behind this are unclear, and may reflect an interplay of patient characteristics, health disparities, and the receipt of inpatient tobacco control processes. OBJECTIVES: We aimed to assess potential disparities in treatment for tobacco use following discharge for COPD, examined in the context of inpatient tobacco control processes. PARTICIPANTS: Smokers aged ≥ 40 years, admitted for treatment of a COPD exacerbation within the VA Veterans Integrated Service Network 20, identified using ICD-9 discharge codes and admission diagnoses from 2005–2012. MAIN MEASURES: The outcome was any tobacco cessation medication dispensed within 48 hours of discharge. We assessed potential predictors administratively up to 1 year prior to admission. We created the final logistic regression model using manual model building, clustered by site. Variables with p < 0.2 in biviariate models were considered for inclusion in the final model. RESULTS: We identified 1511 subjects. 16.9 % were dispensed a medication at discharge. In the adjusted model, several predictors were associated with decreased odds of receiving medications: older age (OR per year older 0.96, 95 % CI 0.95–0.98), black race (OR 0.34, 95 % CI 0.12–0.97), higher comorbidity score (OR 0.89, 95 % CI 0.82–0.96), history of psychosis (OR 0.40, 95 % CI 0.31–0.52), hypertension (OR 0.75, 95 % CI 0.62–0.90), and treatment with steroids in the past year (OR 0.80, 95 % CI 0.70–0.90). Inpatient tobacco control processes were associated with increased odds of receiving medications: documented brief counseling at discharge (OR 3.08, 95 % CI 2.02–4.68) and receipt of smoking cessation medications while inpatient (OR 5.95, 95 % CI 3.19–11.10). CONCLUSIONS: Few patients were treated with tobacco cessation medications at discharge. We found evidence for disparities in treatment, but also potentially beneficial effects of inpatient tobacco control measures. Further focus should be on using novel processes of care to improve provision of medications and decrease the observed disparities.
Bibliographical noteFunding Information:
This material is based upon work supported by the Department of Veterans Affairs, Health Services Research and Development (HSR&D), who provided access to data, office space, and programming and data management. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. We would like to acknowledge Mr. Robert Plumley, who performed the data extraction and natural language processing necessary to complete this project. Dr. Au is an unpaid research consultant for Analysis Group. Dr. Melzer is supported by an institutional F-32 (HL007287-36) through the University of Washington Department of Pulmonary and Critical Care. Dr. Feemster is supported by an NIH NHLBI K23 Mentored Career Development Award (HL111116). Partial support of this project was provided by Gilead Sciences with research funding to the Seattle Institute for Biomedical and Clinical Research. Additional support was received through the VA Health Services Research and Development (HSR&D).
© 2016, Society of General Internal Medicine.
- nicotine replacement
- processes of care