Use of a learning collaborative to support implementation of integrated care for smoking cessation for veterans with posttraumatic stress disorder

Abstract

Objectives: We evaluated the feasibility of incorporating integrated care (IC) for smoking cessation into routine treatment for posttraumatic stress disorder (PTSD) at Department of Veterans Affairs (VA) Medical Centers and the utility of the Learning Collaborative (LC) model in facilitating implementation.

Methods: We conducted 2 LCs aimed at implementing IC for smoking cessation using multidisciplinary teams comprising 70 staff members from 12 VA PTSD clinics. Using questionnaires, we evaluated providers' perceptions of the LC methodology and the effectiveness and feasibility of routine IC delivery. We assessed number of providers delivering and patients receiving IC using medical record data.

Results: More than 85% of participating VA staff considered the LC to be an effective training and implementation platform. The majority thought IC effectively addressed an important need and could be delivered in routine PTSD care. All LC participants who planned to deliver IC did so (n=52). Within 12 months of initial training, an additional 46 locally trained providers delivered IC and 395 veterans received IC.

Conclusions: The LC model effectively facilitated rapid and broad implementation of IC. Facilitators and barriers to sustained use of IC are unknown and should be identified to understand how best to promote ongoing access to evidence-based treatment for smoking cessation in mental health populations.

FIGURE 1—

Flow and structure of Integrated Care Learning Collaborative 1: Department of Veterans Affairs, April 2010–September 2012. Source. Adapted from Institute for Healthcare Improvement 2013.