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Facilitation to Increase Tobacco Treatment

External Facilitation to Expand Reach of Tobacco Treatment to SMI Veterans

Who can join

All ages · All sexes

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

About the study

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.

What is being tested

• Multi-component facilitation (other)

Sponsor: VA Office of Research and Development · Participants: 65 · Started: Aug 3, 2026

Contact the study team

• Corinne N Kacmarek, PhD · Phone: (410) 340-0727
• Frederick M Ivey, PhD · Phone: (410) 605-7000

Official record on ClinicalTrials.gov — NCT07455526

Locations in the U.S.

Conditions

• Quitting Smoking (Tobacco Use Disorder)
• Mental Disorders

From ClinicalTrials.gov, data retrieved Nov 15, 2026. Each study sets its own eligibility; the study team decides who can join.