Implementing Smoking Cessation Guidelines for Hospitalized Veterans: Effects on Nurse Attitudes and Performance

Katz, David A.; Holman, John E.; Johnson, Skyler; Hillis, Stephen L.; Ono, Sarah S.; Stewart, Kenda R.; Paez, Monica; Fu, Steven S.; Grant, Kathleen M.; Buchanan, Lynne; Prochazka, Allan V.; Battaglia, Catherine; Titler, Marita G.; Weg, Mark W. Vander

doi:10.1007/s11606-013-2464-7

Cited by 20 publications

(20 citation statements)

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“…This finding is congruent with a Cochrane Collaborative Review that demonstrated that health professional training increases the delivery of smoking cessation interventions [59]. Implementing standard protocols, which have been shown to be effective in increasing smoking cessation counseling interventions provided by nurses [60], likely enhanced service delivery [61]. Nurses are ideally positioned to deliver cessation interventions because (1) physician time is at a premium, (2) nurses are educated in psychosocial and physiological interventions, (3) nurses have access to and immediate rapport with patients as well as respect from physicians, (4) nurses understand the patient’s medical condition and can tailor the intervention accordingly, and (5) nurses can read charts, initiate medication orders, and write nursing notes.…”

Section: Discussionsupporting

confidence: 74%

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

et al. 2016

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BackgroundGuided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework.MethodsThis pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention.Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended).Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive (“user friendly,” “streamlined,” or “saves time”), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended.ConclusionsGiven that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation.Trial registrationClinicalTrials.gov, NCT01309217 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0511-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 74%

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

et al. 2016

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“…35 However, counseling interventions are generally delivered by a research nurse or trained smoking-cessation counselor, not by a nurse who is responsible for other aspects of patients’ clinical care. 6 Others suggest brief cessation services can be added effectively to unit nurse duties, 19,35,36 but the impact on delivery and outcomes appears limited. 6,31,35 Hospitals involved in this study supported the use of dedicated staff to deliver bedside tobacco consult services and referrals.…”

Section: Discussionmentioning

confidence: 99%

Referring Hospitalized Smokers to Outpatient Quit Services

Fellows

Mularski

Leo

et al. 2016

American Journal of Preventive Medicine

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Introduction Linking outpatient cessation services to bedside counseling for hospitalized smokers can improve long-run quit rates. Adding an assisted referral (AR) offer to a tobacco treatment specialist consult service fits the team approach to care in U.S. hospitals. Design A two-arm patient-randomized trial tested the effectiveness of adding an AR offer to outpatient smoking-cessation services and interactive voice recognition (AR+IVR) follow-up to a usual care (UC) tobacco-cessation consult for hospitalized smokers. Setting/participants Over 24 months (November 2011–November 2013), 898 hospitalized adult smokers interested in quitting smoking were recruited from three large hospitals in the Portland, Oregon area: an integrated group model HMO (n=622), a community hospital (n=195), and an academic health center (n=81). Intervention Tobacco treatment specialists identified smokers and provided an intensive bedside tobacco use assessment and cessation consultation (UC). AR+IVR recipients also received proactive ARs to available outpatient counseling programs and medications, and linked patients to a tailored IVR telephone follow-up system. Main outcome measures The primary outcome was self-reported 30-day abstinence at 6-month follow-up. Secondary outcomes included self-reported and continuous abstinence and biochemically confirmed 7-day abstinence at 6 months. Follow-up was completed in September 2014; data were analyzed in 2015. Results A total of 597 and 301 hospitalized smokers were randomized to AR+IVR and UC, respectively. AR+IVR and UC recipients received 19.3 and 17.0 minutes of bedside counseling (p=0.372), respectively. Most (58%) AR+IVR patients accepted referrals for counseling, 43% accepted medications, and 28% accepted both. Self-reported 30-day abstinence for AR+IVR (17.9%) and UC (17.3%) were not statistically significant (p=0.569). Differences in 7-day, continuous, and biochemically confirmed abstinence by treatment group also were insignificant, overall and adjusting for site. Conclusions Adding an AR to outpatient counseling and medications did not increase cigarette abstinence at 6 months compared to UC alone.

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“…Details regarding the study methodology and intervention have been reported elsewhere (Katz, Holman, Johnson, et al, 2013; Katz et al, 2014; Katz et al, 2009). Briefly, the study utilized a multi-site, prepost quasi-experimental design.…”

Section: Methodsmentioning

confidence: 99%

“…We recently reported the impact of an enhanced academic detailing intervention involving face-to-face educational outreach regarding evidence-based tobacco cessation intervention strategies (Fiore et al, 2008), performance feedback, and the use of peer champions on nurses' delivery of guideline-recommended actions (based on the 5A's model) in four Veterans Administration hospitals (Katz, Holman, Johnson, et al, 2013; Katz et al, 2014). The primary aim of the present study was to determine the effectiveness of this nurse-initiated intervention with regard to cessation outcomes in hospitalized smokers.…”

Section: Introductionmentioning

confidence: 99%

Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial

Weg

Holman

Rahman

et al. 2017

Journal of Substance Abuse Treatment

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Purpose To examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers. Design Pre-post quasi-experimental trial. Setting General medical units of four US Department of Veterans Affairs hospitals. Subjects 898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively). Intervention The intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback. Measures The primary outcome was self-reported 7-day point prevalence abstinence at six months. Analysis Tobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression. Results Seven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio (AOR) and 95% confidence interval (CI95) = 0.78 [0.51–1.18]) or six months (AOR = 0.92; CI95 = 0.62–1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect (p = 0.0004) and perceived likelihood of staying off cigarettes following discharge (p < 0.0001). Conclusions Tobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.

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Implementing Smoking Cessation Guidelines for Hospitalized Veterans: Effects on Nurse Attitudes and Performance

Abstract: A multifaceted intervention including academic detailing and adaptation of the nursing admission template is an effective strategy for improving nurses' delivery of brief cessation counseling in medical inpatients.

Cited by 20 publications

References 35 publications

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

Referring Hospitalized Smokers to Outpatient Quit Services

Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial

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