Referring Hospitalized Smokers to Outpatient Quit Services

Abstract

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.

Cessation for smokers seeking treatment and advice from health care professionals in the hospital setting

“…Multicomponent interventions for inpatient smoking cessation are widely encouraged by best-practice guidelines ( Fiore et al 2000 ;West et al ;Global Initiative for Chronic Obstructive Lung Disease 2015 ;Yang et al 2016 ). Most studies found in this review evaluated a bedside counselling program combined with NRT and post-discharge telephone and/or outpatient cessation support.…”

“…One can provide face-to-face counselling ( Lancaster and Stead 2005 ) or can refer to a telephone counselling service , hereafter referred to as a Quitline. Alternatively, there are a number of smoking cessation medications that can assist during a quit attempt, including varenicline tartrate (varenicline) ( Ebbert et al 2010 ;Cahill et al 2013 ), bupropion hydrochloride (bupropion) ( Raupach and van Schayck 2011 ;Cahill et al 2013 ) or nicotine replacement therapy (NRT) ( Ferguson et al 2011 ;Cahill et al 2013 ). Combining pharmacotherapy and counselling, hereafter referred to as a multicomponent strategy, is an additional option, which has been shown to increase quit rates from 10 to 25 percent compared to pharmacotherapy alone ( Stead and Lancaster 2012 ).…”

“…Healthcare institutes' practices and specific organisational policies in relation to smoking cessation are often underutilised, ad hoc, outdated and  variable between institutions, departments, and even individual healthcare practitioners ( Freund et al 2008 ;Freund et al 2009 ;Bartels et al 2012 ;George et al 2012 ;Ohakim et al 2015 ). In the hospital setting, anecdotal and published evidence suggests that clinical practice guidelines for smoking cessation are sub-optimally translated into practice ( Fiore et al 2012 ;Freund et al 2009 ;Regan et al 2012 ;Slattery et al 2016 ;Smith et al 2012 ), despite a growing evidence base underpinning the recommendations. This is a substantial missed opportunity for effective intervention, with almost 300,000 hospitalisations per year in Australia attributable to cigarette smoking ( Hurley 2006 ).…”

Effects of post-discharge counseling and medication utilization on short and long-term smoking cessation among hospitalized patients

“…Providing smoking cessation medications for patients as an adjunct to counseling significantly improves long term quit rates (Fiore et al, 2008). A number of studies have examined methods for implementing these two elements of care into hospital treatment and post-discharge care planning (Sherman et al, 2016; Rigotti et al, 2016; Rigotti and Stoney, 2016; Richter et al, 2016; Harrington et al, 2016; Fellows et al, 2016; Duffy et al, 2016; Cummins et al, 2016).…”

Evaluation of a Systems-Based Tobacco Cessation Program Using Bedside Volunteers

“…4 However, only 1% of tobacco users use Quitlines. 4 The Consortium of Hospitals to Advance Research on Tobacco (CHART) studies reported mixed results on effectiveness of Quitline fax-referral [5][6][7][8][9][10] and concluded that engaging tobacco users in post-discharge treatment is a challenge. 3 We implemented and evaluated a systems-based approach for inpatient tobacco cessation that utilized trained bedside volunteers with the goals of Quitline referral and tobacco cessation.…”