Vascular Physician Offer and Report (VAPOR) Trial

Project: Research project

Description

While the overall prevalence of smoking among US adults is approximately one in five, the proportion of active smokers among vascular surgery patients is nearly twice as high, as greater than one in three patients with peripheral arterial disease (PAD) smokes tobacco. Smoking is consistently associated with poor health outcomes, including increased risk for amputation, peripheral graft occlusion, and mortality. Finally, smoking represents the leading cause of preventable disease and death in the US, resulting in an estimated 443,000 deaths and $193 billion in direct health care spending and productivity losses each year. Although smoking cessation is a national priority, quitting smoking is difficult. Smoking cessation often requires multiple attempts, and ultimately fewer than 10% of smokers who try to quit are successful.

Vascular surgeons are uniquely and auspiciously positioned to help smokers quit. First, vascular surgeons treat a large number of patients who smoke. Second, vascular surgeons have a vested interest in smoking cessation, as it improves the outcomes of vascular care. And third, vascular surgeons have the opportunity to make the surgical episode a “teachable moment”, wherein the invasive nature of our treatment encourages patients to quit. But while the Society for Vascular Surgery advocates smoking cessation at every visit, there is dramatic variation in the frequency and manner with which vascular surgeons approach this task.

In order to improve success in smoking cessation for patients undergoing vascular care, we propose a national pilot trial of the “Offer and Report” protocol, a simple, standardized smoking cessation initiative developed in 2013 with an expert in smoking cessation, Dr. Nancy Rigotti, and implemented in 2014 in the Vascular Study Group of New England (VSGNE). The “Offer and Report” protocol is a framework providing standardization in physician provision of (1) “very brief advice,” (2) referral to telephone-based smoking cessation counseling, and (3) consideration of prescribing nicotine replacement therapy (NRT) or other pharmacotherapy to assist in smoking cessation. The three elements of “Offer and Report” were chosen because each has been proven to be effective in assisting smoking cessation. The goal of VAPOR is to assist surgeons in effectively and efficiently integrating smoking cessation into routine outpatient clinic visits, and therefore broadly improve the outcomes of vascular care.
StatusFinished
Effective start/end date12/23/1412/23/17

Funding

  • Mary Hitchcock Memorial Hospital (DUA Agmt Dtd 12/23/2014)
  • Society for Vascular Surgery (DUA Agmt Dtd 12/23/2014)

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Smoking Cessation
Blood Vessels
Physicians
Smoking
Smoke
New England
Peripheral Arterial Disease
Ambulatory Care
Ambulatory Care Facilities
Nicotine
Amputation
Telephone
Tobacco
Surgeons
Counseling
Referral and Consultation
Delivery of Health Care
Transplants
Efficiency
Drug Therapy