INTRODUCTION While initiation rates of tobacco cessation pharmacotherapy have improved both inside and outside the Department of Veteran Affairs (VA), prescribing rates remain low. The objective of this study was to examine correlation of the characteristics of providers, clinics, and facilities with initiation of tobacco cessation pharmacotherapy. METHODS This retrospective, observational study used VA outpatient electronic medical record data from federal fiscal year 2011. Logistic regression models estimated the adjusted odds ratio associated with provider characteristics for pharmacotherapy initiation. RESULTS For the 639507 veterans who used tobacco, there were 30388 providers caring for them. Younger (p<0.001) and female (p<0.001) providers were more likely to initiate tobacco cessation pharmacotherapy. Compared to physicians, pharmacists were 74% more likely to initiate pharmacotherapy, while all groups of nurses were 5-8% and physicians' assistants were 12% less likely (p<0.001). Compared to those seen in primary care clinics, patients assessed in substance use treatment clinics were 16% more likely to have pharmacotherapy initiated (p<0.001), while those in psychiatry were 10% less likely (p<0.001), and those in outpatient surgery were 39% less likely to initiate pharmacotherapy (p<0.001). Compared to almost all other classes of VA facilities, patients seen in primary care community-based outpatient clinics (CBOCs) were 7-28% more likely to initiate pharmacotherapy (p<0.0001). CONCLUSIONS While the VA is at the leading edge of providing tobacco cessation pharmacotherapy, targeting quality improvement efforts towards providers, clinics, and facilities with low prescribing rates will be essential to continue the declining rates of tobacco use among VA patients.

中文翻译：

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退伍军人健康管理局提供的与烟草药物治疗相关的提供者和临床环境特征。

引言 尽管退伍军人事务部 (VA) 内外的戒烟药物治疗的启动率都有所提高，但处方率仍然很低。本研究的目的是检查提供者、诊所和设施的特征与开始戒烟药物治疗的相关性。方法 这项回顾性、观察性研究使用了 2011 年联邦财政年度的 VA 门诊电子病历数据。逻辑回归模型估计了与药物治疗启动的提供者特征相关的调整优势比。结果 在 639507 名使用烟草的退伍军人中，有 30388 名提供者照顾他们。年轻 (p<0.001) 和女性 (p<0.001) 提供者更有可能开始戒烟药物治疗。与医生相比，药剂师开始药物治疗的可能性要高 74%，而所有护士组的可能性是 5-8%，医生助理的可能性要低 12%（p<0.001）。与在初级保健诊所就诊的患者相比，在物质使用治疗诊所接受评估的患者开始药物治疗的可能性要高 16% (p<0.001)，而精神病学患者的可能性要低 10% (p<0.001)，而门诊患者手术开始药物治疗的可能性降低 39%（p<0.001）。与几乎所有其他类别的 VA 设施相比，在初级保健社区门诊 (CBOC) 就诊的患者开始药物治疗的可能性要高 7-28%（p<0.0001）。结论 虽然 VA 在提供戒烟药物治疗方面处于领先地位，但针对提供者、诊所、