used by VA. The committee was unable to determine which standardized tobacco-cessation programs are used by VA medical facilities and whether there is any mechanism for determining which are most effective for veteran populations. All VA medical facilities must offer some type of tobacco-cessation program even if it is only a brief counseling session with a clinician during an office visit and a prescription for medications. The VA has made progress in reducing some barrier to access to tobacco-cessation interventions such as eliminating the copay for tobacco-cessation counseling at VA facilties. Many of the smaller outpatient clinics and CBOCs that do not have staff available or trained to run tobacco-cessation programs cannot offer more than brief counseling and prescriptions and refer veterans to local health departments or state quitlines for more intensive counseling (Jean Beckham, VA, personal communication, July 18, 2008; Timothy Carmody, VA, personal communication, July 15, 2008; Clint McSherry, VA, personal communication, July 29, 2008). The disconnect between receiving tobacco-cessation counseling outside VA and for receiving tobacco-cessation medications from VA makes it difficult for clinicians to follow up and assist patients, and it may pose a barrier for veterans seeking treatment for tobacco use.
Tobacco-Cessation Programs Used by VA