RECRUITING Not applicable ClinicalTrials.gov

Facilitation to Increase Tobacco Treatment

Sponsor: VA Office of Research and Development • ClinicalTrials.gov ID: NCT07455526

Registry updated: 2026-10-15

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Description

Smoking disproportionally impacts Veterans, and VA spends $2.7 billion annually on smoking-related health conditions. Veterans with serious mental illness (SMI) smoke tobacco products at triple the rate of Veterans without any mental illness and die 10-15 years earlier as a result. SMI Veterans who smoke want to quit and FDA-approved tobacco cessation medications are safe, effective, and readily available in VA. However, mental health providers are hesitant to treat smoking and just 11-18% of Veterans with SMI who smoke receive tobacco medication. External facilitation is an effective implementation strategy that can overcome barriers to integrating evidence-based treatment into routine clinical practice. In collaboration with local and operational partners, the proposed CDA-2 will evaluate and refine an external facilitation strategy to improve tobacco medication prescribing in VA SMI clinics. This proposal aligns with VA priorities to enhance timely access to care and improve Veteran outcomes.

Interventions

Multi-component facilitation (Other)
Facilitation includes identifying multilevel barriers to change, selecting implementation activities to address known barriers, tailoring implementation activities to the local context, providing social support, problem-solving challenges, conducting administrative duties, and refining implementation activities over time in response to data-driven needs for improvement. Facilitation will support multiple other evidence-based implementation activities like auditing performance with feedback and engaging patients. The proposed study will use an external facilitator - someone outside the clinic with expertise in implementation science and tobacco treatment - to partner with clinic representatives and operational leaders who share a commitment to increasing adoption of tobacco medication.

Eligibility criteria

Inclusion Criteria: Providers: * VA Maryland Health Care System patient care providers serving Veterans in Critical Time Intervention, Psychosocial Rehabilitation and Recovery Center, Mental Health Integrative Case Management, or outpatient psychiatry clinics Veterans receiving direct letters: * Had an appointment in VA Maryland Health Care System, Critical Time Intervention, Psychosocial Rehabilitation and Recovery Center, Mental Health Integrative Case Management, or outpatient psychiatry clinics in the last 30 days * Diagnosed with a serious mental illness * Positive tobacco use screen * Appointment scheduled with an outpatient psychiatric prescriber in the next 30 days * Of note, study staff are not directly recruiting Veterans for this implementation intervention component Veteran chart review: * All Veterans actively enrolled in VAMHCS medical facilities with at least one encounter during a given period with available smoking health factor data * Of note, study staff are not directly recruiting Veterans for this data analysis Exclusion Criteria: Providers: * None Veterans receiving direct letters: * Active prescription for bupropion, varenicline, or any nicotine replacement therapy

Conditions

Serious Mental Illness Tobacco Use Disorder

Locations

Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD — Baltimore, Maryland, United States

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Official Source

Data sourced from ClinicalTrials.gov, a service of the U.S. National Institutes of Health.

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