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Konyalıhatipoğlu EB, Karadoğan D, Telatar TG, Şahin Ü. Mid-term outcomes of a smoking cessation program in hospitalized patients in Türkiye. Tob Induc Dis 2024; 22:TID-22-138. [PMID: 39081591 PMCID: PMC11288063 DOI: 10.18332/tid/191239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/11/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION 'Teachable moments', such as inpatient treatment periods, can be turned into opportunities for smokers to acquire healthy living behaviors. This study was conducted to evaluate the outcomes of smoking cessation interventions in an inpatient hospital setting. METHODS Data were collected for this single-arm prospective intervention cohort study between October 2021 and March 2022 from hospitalized patients at Recep Tayyip Erdoğan University Training and Research Hospital in Türkiye. Smoker patients received smoking cessation counseling and brief smoking cessation interventions during their hospitalization and were informed about how to apply to our hospital's smoking cessation outpatient clinic after discharge. They were followed via phone on the 3rd, 5th, and 7th day and the 1st, 3rd, 6th, and 12th month after their discharge, regarding their quit status as well as admissions to smoking cessation clinics. Quitters were confirmed by exhaled air carbon monoxide testing. Logistic regression analysis was performed to evaluate the presence of admission to the emergency department and family physicians at follow-up at 1st year. The model was adjusted in terms of age, sex, presence of malignancy, and education level. RESULTS Of the 183 patients included in the study, 163 participants completed periodic follow-up during one year, with quit rate of 47.2%. The rate of anxiety was higher among non-quitters compared to quitters (9.4% vs 1.2%) (p=0.024). Non-quitters were 19 times more likely to have emergency department admissions (AOR=19.64; 95% CI: 8.08-47.68) and eight times more likely to have family doctor visits (AOR=8.43; 95% CI: 4.05-17.53) than quitters. CONCLUSIONS This cessation program evaluated the quit rates of hospitalized patients in the first year and revealed that the rate of anxiety was higher in non-quitters compared to quitters. It would be an important approach to include psychiatric support in this practice.
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Affiliation(s)
- Esin B. Konyalıhatipoğlu
- Department of Chest Diseases, Recep Tayyip Erdoğan University, School of Medicine, Rize, Türkiye
| | - Dilek Karadoğan
- Department of Chest Diseases, Recep Tayyip Erdoğan University, School of Medicine, Rize, Türkiye
| | - Tahsin Gökhan Telatar
- Department of Public Health, Recep Tayyip Erdoğan University, School of Medicine, Rize, Türkiye
| | - Ünal Şahin
- Department of Chest Diseases, Recep Tayyip Erdoğan University, School of Medicine, Rize, Türkiye
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Khan M, Memedovich A, Eze N, Asante B, Adhikari K, Dunn R, Clement F. Interactive voice response (IVR) for tobacco cessation: a systematic review. BMJ Open 2024; 14:e081972. [PMID: 38986561 PMCID: PMC11243215 DOI: 10.1136/bmjopen-2023-081972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/19/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVE To summarise the uses, outcomes and implementation of interactive voice response (IVR) as a tobacco cessation intervention. DATA SOURCES A systematic review was conducted. Searches were performed on 3 May 2023. The strategies used keywords such as "tobacco cessation", "smoking reduction" and "interactive voice recording". Ovid MEDLINE ALL, Embase, APA PsycINFO, CINAHL, Cochrane Library and Web of Science were searched. Grey literature searches were also conducted. STUDY SELECTION Titles and abstracts were assessed by two independent reviewers. Studies were included if IVR was an intervention for tobacco cessation for adults; any outcomes were reported and study design was comparative. Any abstract included by either reviewer proceeded to full-text review. Full texts were reviewed by two independent reviewers. DATA EXTRACTION Data were independently extracted by two reviewers using a standardised form. The Risk of Bias Tool for Randomised Trials and the Risk of Bias in Non-Randomised Studies of Interventions tools were used to assess study quality. DATA SYNTHESIS Of 308 identified abstracts, 20 moderate-quality to low-quality studies were included. IVR was used standalone or adjunctly as a treatment, follow-up or risk-assessment tool across populations including general smokers, hospitalised patients, quitline users, perinatal women, patients with cancer and veteran smokers. Effective studies found that IVR was delivered more frequently with shorter follow-up times. Significant gaps in the literature include a lack of population diversity, limited implementation settings and delivery schedules, and limited patient and provider perspectives. CONCLUSIONS While the evidence is weak, IVR appears to be a promising intervention for tobacco cessation. However, pilot programmes and research addressing literature gaps are necessary.
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Affiliation(s)
- Maha Khan
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ally Memedovich
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nkiruka Eze
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Benedicta Asante
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kamala Adhikari
- Provincial Population and Public Health, Holy Cross Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Rachel Dunn
- Provincial Population and Public Health, Holy Cross Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Fiona Clement
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2497-2604. [PMID: 38752899 DOI: 10.1016/j.jacc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Cummings KM, Talbot V, Roberson A, Bliss AA, Likins E, Brownstein NC, Stansell S, Adams-Ludd D, Harris B, Louder D, McCutcheon E, Zebian R, Rojewski AM, Toll BA. Implementation of an "opt-out" tobacco treatment program in six hospitals in South Carolina. BMC Health Serv Res 2024; 24:741. [PMID: 38886764 PMCID: PMC11184783 DOI: 10.1186/s12913-024-11205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Describe the screening, referral, and treatment delivery associated with an opt-out tobacco treatment program (TTP) implemented in six hospitals varying in size, rurality and patient populations. METHODS Between March 6, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to six hospitals affiliated with the Medical University of South Carolina were screened for smoking status. The hospitals ranged in size from 82 to 715 beds. Those currently smoking were automatically referred to one of two tobacco treatment options: 1) Enhanced care (EC) where patients could receive a bedside consult by a trained tobacco treatment specialist plus an automated post-discharge follow-up call designed to connect those smoking to the South Carolina Quitline (SCQL); or 2) Basic care (BC) consisting of the post-discharge follow-up call only. An attempt was made to survey patients at 6-weeks after hospitalization to assess smoking status. RESULTS Smoking prevalence ranged from 14 to 49% across the six hospitals; 6,000 patients were referred to the TTP.The delivery of the bedside consult varied across the hospitals with the lowest in the Charleston hospitals which had the highest caseload of referred patients per specialist. Among patients who received a consult visit during their hospitalization, 50% accepted the consult, 8% opted out, 3% claimed not to be current smokers, and 38% were unavailable at the time of the consult visit. Most of those enrolled in the TTP were long-term daily smokers.Forty-three percent of patients eligible for the automated post-discharge follow-up call answered the call, of those, 61% reported smoking in the past seven days, and of those, 34% accepted the referral to theSCQL. Among the 986 of patients surveyed at 6-weeks after hospitalization quit rates ranged from 20%-30% based on duration of reported cessation and were similar between hospitals and for patients assigned to EC versus BC intervention groups. CONCLUSION Findings demonstrate the broad reach of an opt-out TTP. Elements of treatment delivery can be improved by addressing patient-to-staffing ratios, improving systems to prescribe stop smoking medications for patients at discharge and linking patients to stop smoking services after hospital discharge.
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Affiliation(s)
- K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | | | - Avery Roberson
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Asia A Bliss
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Emily Likins
- University of Pikeville, Kentucky College of Osteopathic Medicine, Pikeville, USA
| | - Naomi C Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Stephanie Stansell
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - Demetress Adams-Ludd
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - Bridget Harris
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - David Louder
- MUSC Health Alliance, Medical University of South Carolina, Charleston, USA
| | | | - Rami Zebian
- MUSC Health Florence Division, Florence, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1313-e1410. [PMID: 38743805 DOI: 10.1161/cir.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Streck JM, Rigotti NA, Livingstone-Banks J, Tindle HA, Clair C, Munafò MR, Sterling-Maisel C, Hartmann-Boyce J. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev 2024; 5:CD001837. [PMID: 38770804 PMCID: PMC11106804 DOI: 10.1002/14651858.cd001837.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND In 2020, 32.6% of the world's population used tobacco. Smoking contributes to many illnesses that require hospitalisation. A hospital admission may prompt a quit attempt. Initiating smoking cessation treatment, such as pharmacotherapy and/or counselling, in hospitals may be an effective preventive health strategy. Pharmacotherapies work to reduce withdrawal/craving and counselling provides behavioural skills for quitting smoking. This review updates the evidence on interventions for smoking cessation in hospitalised patients, to understand the most effective smoking cessation treatment methods for hospitalised smokers. OBJECTIVES To assess the effects of any type of smoking cessation programme for patients admitted to an acute care hospital. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 7 September 2022. SELECTION CRITERIA We included randomised and quasi-randomised studies of behavioural, pharmacological or multicomponent interventions to help patients admitted to hospital quit. Interventions had to start in the hospital (including at discharge), and people had to have smoked within the last month. We excluded studies in psychiatric, substance and rehabilitation centres, as well as studies that did not measure abstinence at six months or longer. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was abstinence from smoking assessed at least six months after discharge or the start of the intervention. We used the most rigorous definition of abstinence, preferring biochemically-validated rates where reported. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 82 studies (74 RCTs) that included 42,273 participants in the review (71 studies, 37,237 participants included in the meta-analyses); 36 studies are new to this update. We rated 10 studies as being at low risk of bias overall (low risk in all domains assessed), 48 at high risk of bias overall (high risk in at least one domain), and the remaining 24 at unclear risk. Cessation counselling versus no counselling, grouped by intensity of intervention Hospitalised patients who received smoking cessation counselling that began in the hospital and continued for more than a month after discharge had higher quit rates than patients who received no counselling in the hospital or following hospitalisation (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.24 to 1.49; 28 studies, 8234 participants; high-certainty evidence). In absolute terms, this might account for an additional 76 quitters in every 1000 participants (95% CI 51 to 103). The evidence was uncertain (very low-certainty) about the effects of counselling interventions of less intensity or shorter duration (in-hospital only counselling ≤ 15 minutes: RR 1.52, 95% CI 0.80 to 2.89; 2 studies, 1417 participants; and in-hospital contact plus follow-up counselling support for ≤ 1 month: RR 1.04, 95% CI 0.90 to 1.20; 7 studies, 4627 participants) versus no counselling. There was moderate-certainty evidence, limited by imprecision, that smoking cessation counselling for at least 15 minutes in the hospital without post-discharge support led to higher quit rates than no counselling in the hospital (RR 1.27, 95% CI 1.02 to 1.58; 12 studies, 4432 participants). Pharmacotherapy versus placebo or no pharmacotherapy Nicotine replacement therapy helped more patients to quit than placebo or no pharmacotherapy (RR 1.33, 95% CI 1.05 to 1.67; 8 studies, 3838 participants; high-certainty evidence). In absolute terms, this might equate to an additional 62 quitters per 1000 participants (95% CI 9 to 126). There was moderate-certainty evidence, limited by imprecision (as CI encompassed the possibility of no difference), that varenicline helped more hospitalised patients to quit than placebo or no pharmacotherapy (RR 1.29, 95% CI 0.96 to 1.75; 4 studies, 829 participants). Evidence for bupropion was low-certainty; the point estimate indicated a modest benefit at best, but CIs were wide and incorporated clinically significant harm and clinically significant benefit (RR 1.11, 95% CI 0.86 to 1.43, 4 studies, 872 participants). Hospital-only intervention versus intervention that continues after hospital discharge Patients offered both smoking cessation counselling and pharmacotherapy after discharge had higher quit rates than patients offered counselling in hospital but not offered post-discharge support (RR 1.23, 95% CI 1.09 to 1.38; 7 studies, 5610 participants; high-certainty evidence). In absolute terms, this might equate to an additional 34 quitters per 1000 participants (95% CI 13 to 55). Post-discharge interventions offering real-time counselling without pharmacotherapy (RR 1.23, 95% CI 0.95 to 1.60, 8 studies, 2299 participants; low certainty-evidence) and those offering unscheduled counselling without pharmacotherapy (RR 0.97, 95% CI 0.83 to 1.14; 2 studies, 1598 participants; very low-certainty evidence) may have little to no effect on quit rates compared to control. Telephone quitlines versus control To provide post-discharge support, hospitals may refer patients to community-based telephone quitlines. Both comparisons relating to these interventions had wide CIs encompassing both possible harm and possible benefit, and were judged to be of very low certainty due to imprecision, inconsistency, and risk of bias (post-discharge telephone counselling versus quitline referral: RR 1.23, 95% CI 1.00 to 1.51; 3 studies, 3260 participants; quitline referral versus control: RR 1.17, 95% CI 0.70 to 1.96; 2 studies, 1870 participants). AUTHORS' CONCLUSIONS Offering hospitalised patients smoking cessation counselling beginning in hospital and continuing for over one month after discharge increases quit rates, compared to no hospital intervention. Counselling provided only in hospital, without post-discharge support, may have a modest impact on quit rates, but evidence is less certain. When all patients receive counselling in the hospital, high-certainty evidence indicates that providing both counselling and pharmacotherapy after discharge increases quit rates compared to no post-discharge intervention. Starting nicotine replacement or varenicline in hospitalised patients helps more patients to quit smoking than a placebo or no medication, though evidence for varenicline is only moderate-certainty due to imprecision. There is less evidence of benefit for bupropion in this setting. Some of our evidence was limited by imprecision (bupropion versus placebo and varenicline versus placebo), risk of bias, and inconsistency related to heterogeneity. Future research is needed to identify effective strategies to implement, disseminate, and sustain interventions, and to ensure cessation counselling and pharmacotherapy initiated in the hospital is sustained after discharge.
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Affiliation(s)
- Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts (MA), USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hilary A Tindle
- Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carole Clair
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Marcus R Munafò
- School of Experimental Psychology and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
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Vander Weg MW, Howren MB, Grant KM, Prochazka AV, Duffy S, Burke R, Cretzmeyer M, Parker C, Thomas EBK, Rizk MT, Bayer J, Kinner EM, Clark JM, Katz DA. A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209191. [PMID: 37866436 DOI: 10.1016/j.josat.2023.209191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/24/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. METHODS The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. RESULTS Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting. CONCLUSIONS A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.
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Affiliation(s)
- Mark W Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Community and Behavioral Health, University of Iowa College of Public Health, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Psychological and Brain Sciences, University of Iowa, United States of America; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America.
| | - M Bryant Howren
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America; Department of Behavioral Sciences and Social Medicine, Florida State University, United States of America; Florida Blue Center for Rural Health Research & Policy, United States of America
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System, United States of America; University of Nebraska Medical Center Department of Medicine, United States of America
| | - Allan V Prochazka
- Primary Care, VA Eastern Colorado Health Care System, United States of America; Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States of America
| | - Sonia Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America; College of Nursing, Ohio State University, United States of America
| | - Randy Burke
- Mental Health Service, G.V. (Sonny) Montgomery VA Medical Center, United States of America; Department of Psychiatry, University of Mississippi School of Medicine, United States of America
| | | | - Christopher Parker
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, United States of America
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | | | - Jennifer Bayer
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Ellen M Kinner
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Jennifer M Clark
- Department of Neurology, University of Iowa, Carver College of Medicine, United States of America
| | - David A Katz
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Epidemiology, University of Iowa College of Public Health, United States of America
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Cummings KM, Talbot V, Roberson A, Bliss AA, Likins E, Brownstein NC, Stansell S, Adams-Ludd D, Harris B, Louder D, McCutcheon E, Zebian R, Rojewski A, Toll BA. Implementation of an "Opt-Out" Tobacco Treatment Program in Six Hospitals in South Carolina. RESEARCH SQUARE 2023:rs.3.rs-3318088. [PMID: 37720041 PMCID: PMC10503831 DOI: 10.21203/rs.3.rs-3318088/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Objective To describe the implementation an opt-out tobacco treatment program (TTP) in 6 diverse hospitals located in different regions of South Carolina. Methods Between March 8, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to 6 hospitals affiliated with the Medical University of South Carolina (MUSC) were screened for their cigarette status. Patients who smoked cigarettes were referred to an TTP offering a brief bedside consult and automated post-discharge follow-up calls with an opportunity to receive a referral to the South Carolina Quitline (SCQL). The hospitals included in this study ranged in size from 82 to 715 beds with diverse patient populations. Herein, we report on the results of screening and referring patients to the TTP, delivery of smoking cessation treatments, and patient smoking status assessed in a sample of patients followed 6-weeks after discharge from the hospital. Results Smoking prevalence ranged from 14-49% across the 6 hospitals. Among eligible patients reached, 85.6% accepted the bedside consult. Only 3.4% of patients reached were deemed ineligible because they claimed not to be currently smoking cigarettes. The automated post-discharge follow-up calls were answered by 43% of patients, with about a third of those who had relapsed back to smoking accepting the offer of a referral to the SCQL. Overall, about half of the 6,000 patients referred to the TTP received some type of treatment. Self-reported smoking abstinence rates assessed 6-weeks after discharge were similar across the five acute care hospitals ranging from about 20-30%. Conclusion The findings demonstrate the broad reach of implementing an opt-out TTP for patients in hospitals of varying size, rurality and patient populations.
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Raspe M, Bals R, Bölükbas S, Faber G, Krabbe B, Landmesser U, Al Najem S, Przibille O, Raupach T, Rupp A, Rustler C, Tuffman A, Urlbauer M, Voigtländer T, Andreas S. [Smoking cessation in hospitalised patients - Initiate among inpatients, continue when outpatients - A Position Paper by the German Respiratory Society (DGP) Taskforce for Smoking Cessation]. Pneumologie 2023. [PMID: 37186277 DOI: 10.1055/a-2071-8900] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Tobacco smoking is the greatest preventable health risk. The effects are serious, both individually and societal. Nevertheless, the current prevalence of tobacco smokers in Germany is still high at around 35 %. A recent strong increase in actively smoking adolescents (14- to 17-year-olds, current prevalence approx. 16 %) and young adults (18- to 24-year-olds, current prevalence approx. 41 %) is also a cause for concern. About a third of all inpatients continue smoking while being treated. The hospitalization of active smokers in acute and rehabilitation hospitals serves as a "teachable moment" for initiation of cessation offers. An intervention that begins in hospital and continues for at least a month after discharge results in about 40 % additional smokefree patients. It is scientifically well-researched, effective and cost-efficient. After initiation in hospital these measures can be continued via ambulatory cessation programs, rehabilitation facilities, an Internet or telephone service. In Germany, there are structured and quality-assured cessation offers, both for the inpatient and for the outpatient area. The biggest obstacle to broad establishment of such offers is the lack of reimbursement. Two feasible ways to change this would be the remuneration of the existing OPS 9-501 "Multimodal inpatient treatment for smoking cessation" and the establishment of quality contracts according to § 110a SGB V. An expansion of tobacco cessation measures in healthcare facilities would reduce smoking prevalence, associated burden of disease and consecutive costs.
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Affiliation(s)
- Matthias Raspe
- Charité - Universitätsmedizin Berlin, Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin, und des Berlin Institute of Health, Fächerverbund für Infektiologie, Pneumologie und Intensivmedizin, Klinik für Pneumologie, Beatmungsmedizin und Intensivmedizin mit dem Arbeitsbereich Schlafmedizin, Berlin
| | - Robert Bals
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Serve Bölükbas
- Klinik für Thoraxchirurgie, Universitätsmedizin Essen - Ruhrlandklinik, Essen
| | - Gerhard Faber
- CELENUS Teufelsbad Fachklinik Blankenburg, Blankenburg
| | - Bernd Krabbe
- Herz-Kreislaufmedizin/Angiologie, UKM Marienhospital Steinfurt, Steinfurt
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin
- DZHK (German Centre for Cardiovascular Research), partner site Berlin
| | | | | | - Tobias Raupach
- Universitätsklinikum Bonn (AÖR), Institut für Medizindidaktik, Bonn
| | | | - Christa Rustler
- Deutsches Netz Rauchfreier Krankenhäuser & Gesundheitseinrichtungen DNRfK e. V., Berlin
| | - Amanda Tuffman
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Standort Innenstadt, München, außerdem Deutsches Zentrum für Lungenforschung
| | - Matthias Urlbauer
- Medizinische Klinik 3 (Schwerpunkt Pneumologie) am Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - Thomas Voigtländer
- Deutsche Herzstiftung e. V., Frankfurt
- MVZ CCB Frankfurt und Main-Taunus, Frankfurt
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Immenhausen, außerdem Abteilung Kardiologie und Pneumologie der Universitätsmedizin Göttingen und Deutsches Zentrum für Lungenforschung
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10
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Wechsler PM, Liberman AL, Restifo D, Abramson EL, Navi BB, Kamel H, Parikh NS. Cost-Effectiveness of Smoking Cessation Interventions in Patients With Ischemic Stroke and Transient Ischemic Attack. Stroke 2023; 54:992-1000. [PMID: 36866670 PMCID: PMC10050136 DOI: 10.1161/strokeaha.122.040356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Smoking cessation rates after stroke and transient ischemic attack are suboptimal, and smoking cessation interventions are underutilized. We performed a cost-effectiveness analysis of smoking cessation interventions in this population. METHODS We constructed a decision tree and used Markov models that aimed to assess the cost-effectiveness of varenicline, any pharmacotherapy with intensive counseling, and monetary incentives, compared with brief counseling alone in the secondary stroke prevention setting. Payer and societal costs of interventions and outcomes were modeled. The outcomes were recurrent stroke, myocardial infarction, and death using a lifetime horizon. Estimates and variance for the base case (35% cessation), costs and effectiveness of interventions, and outcome rates were imputed from the stroke literature. We calculated incremental cost-effectiveness ratios and incremental net monetary benefits. An intervention was considered cost-effective if the incremental cost-effectiveness ratio was less than the willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY) or when the incremental net monetary benefit was positive. Probabilistic Monte Carlo simulations modeled the impact of parameter uncertainty. RESULTS From the payer perspective, varenicline and pharmacotherapy with intensive counseling were associated with more QALYs (0.67 and 1.00, respectively) at less total lifetime costs compared with brief counseling alone. Monetary incentives were associated with 0.71 more QALYs at an additional cost of $120 compared with brief counseling alone, yielding an incremental cost-effectiveness ratio of $168/QALY. From the societal perspective, all 3 interventions provided more QALYs at less total costs compared with brief counseling alone. In 10 000 Monte Carlo simulations, all 3 smoking cessation interventions were cost-effective in >89% of runs. CONCLUSIONS For secondary stroke prevention, it is cost-effective and potentially cost-saving to deliver smoking cessation therapy beyond brief counseling alone.
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Affiliation(s)
- Paul M Wechsler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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11
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Grable JC, Lin JK, Peltzer K, Schultz R, Bugbee D, Pilipenko M, Levy SC, Hawkins S. Integrating Tobacco Dependence Treatment into Hospital Practice Using the Rochester Model. J Multidiscip Healthc 2023; 16:905-911. [PMID: 37038455 PMCID: PMC10082598 DOI: 10.2147/jmdh.s400615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/23/2023] [Indexed: 04/07/2023] Open
Abstract
Purpose Delivering evidence-based tobacco dependence treatments to hospital patients in real-world settings continues to be a challenge. To achieve long-term abstinence, a program should provide both bedside counseling and post-discharge contacts. These program features are necessary but difficult to implement due to lack of training, time and low administrative support. The Rochester Model is a tobacco treatment program using existing staff and medical students to reduce the barriers for treating hospitalized smokers. Patients and Methods Any smoking patient admitted to a participating hospital unit can participate. Staff nurses, mid-level providers and physicians deliver the counseling steps during the admission. Nurses hold two bedside counseling sessions, while providers give quitting advice and encourage pharmacotherapy. Nurses also contribute as unit champions and post-discharge call counselors. New York State quit line counselors combined with a University of Rochester call team fulfill the post-discharge calls. The latter call team is composed of staff nurses, respiratory therapists and medical students. Results The number of smoking patients screened was 2610 while 385 enrolled after a proof-of-concept period. The 7-day point prevalence quit rates using the as treated (patients contacted) analysis is 50% at 4 weeks, 42% at 3 months and 38% at 6 months. The 7-day point prevalence quit rates using the intent-to-treat (all patients) analysis is 23% at 4 weeks, 16% at 3 months and 14% at 6 months. Conclusion Preliminary data on the Rochester Model is showing an effective yet affordable tobacco treatment program using hospital staff and medical students. Nurses serve as bedside counselors, unit champions and post-discharge call counselors. Hospitals, even with limited resources, can implement tobacco treatment programs using existing staff.
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Affiliation(s)
- John C Grable
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA
- Correspondence: John C Grable, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY, 14642, USA, Tel +1 585-275-7424, Fax +1 585-276-2820, Email
| | - Jonathan K Lin
- Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kenneth Peltzer
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Rebecca Schultz
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Doris Bugbee
- Department of Nursing, University of Rochester School of Medicine, Rochester, NY, USA
| | - Mikhail Pilipenko
- Department of Nursing, University of Rochester School of Medicine, Rochester, NY, USA
| | - Scott C Levy
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Shayne Hawkins
- Department of Nursing, University of Rochester School of Medicine, Rochester, NY, USA
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12
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Richter KP, Catley D, Gajewski BJ, Faseru B, Shireman TI, Zhang C, Scheuermann TS, Mussulman LM, Nazir N, Hutcheson T, Shergina E, Ellerbeck EF. The Effects of Opt-out vs Opt-in Tobacco Treatment on Engagement, Cessation, and Costs: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:331-339. [PMID: 36848129 PMCID: PMC9972241 DOI: 10.1001/jamainternmed.2022.7170] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 03/01/2023]
Abstract
Importance Tobacco use causes 7 million deaths per year; most national guidelines require people who use tobacco to opt in to care by affirming they are willing to quit. Use of medications and counseling is low even in advanced economy countries. Objective To evaluate the efficacy of opt-out care vs opt-in care for people who use tobacco. Design, Setting, and Participants In Changing the Default (CTD), a Bayesian adaptive population-based randomization trial, eligible patients were randomized into study groups, treated according to group assignment, and debriefed and consented for participation at 1-month follow-up. A total of 1000 adult patients were treated at a tertiary care hospital in Kansas City. Patients were randomized from September 2016 to September 2020; final follow-up was in March 2021. Interventions At bedside, counselors screened for eligibility, conducted baseline assessment, randomized patients to study group, and provided opt-out care or opt-in care. Counselors and medical staff provided opt-out patients with inpatient nicotine replacement therapy, prescriptions for postdischarge medications, a 2-week medication starter kit, treatment planning, and 4 outpatient counseling calls. Patients could opt out of any or all elements of care. Opt-in patients willing to quit were offered each element of treatment described previously. Opt-in patients who were unwilling to quit received motivational counseling. Main Outcomes and Measures The main outcomes were biochemically verified abstinence and treatment uptake at 1 month after randomization. Results Of a total of 1000 eligible adult patients who were randomized, most consented and enrolled (270 [78%] of opt-in patients; 469 [73%] of opt-out patients). Adaptive randomization assigned 345 (64%) to the opt-out group and 645 (36%) to the opt-in group. The mean (SD) age at enrollment was 51.70 (14.56) for opt-out patients and 51.21 (14.80) for opt-out patients. Of 270 opt-in patients, 123 (45.56%) were female, and of 469 opt-out patients, 226 (48.19%) were female. Verified quit rates for the opt-out group vs the opt-in group were 22% vs 16% at month 1 and 19% vs 18% at 6 months. The Bayesian posterior probability that opt-out care was better than opt-in care was 0.97 at 1 month and 0.59 at 6 months. Treatment use for the opt-out group vs the opt-in group was 60% vs 34% for postdischarge cessation medication (bayesian posterior probability of 1.0), and 89% vs 37% for completing at least 1 postdischarge counseling call (bayesian posterior probability of 1.0). The incremental cost-effectiveness ratio was $678.60, representing the cost of each additional quit in the opt-out group. Conclusions and Relevance In this randomized clinical trial, opt-out care doubled treatment engagement and increased quit attempts, while enhancing patients' sense of agency and alliance with practitioners. Stronger and longer treatment could increase cessation. Trial Registration ClinicalTrials.gov Identifier: NCT02721082.
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Affiliation(s)
- Kimber P. Richter
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Delwyn Catley
- Children’s Mercy Hospitals and Clinics, Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri
| | - Byron J. Gajewski
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City
| | - Babalola Faseru
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Theresa I. Shireman
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | | | | | - Laura M. Mussulman
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Niaman Nazir
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Tresza Hutcheson
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Elena Shergina
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City
| | - Edward F. Ellerbeck
- Department of Population Health, University of Kansas School of Medicine, Kansas City
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13
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Gavilan E, Fernández E, Minguell J, Trilla E, Zuriguel-Pérez E, Martínez C. Efficacy of Presurgical Interventions to Promote Smoking Cessation: A Systematic Review. Anesth Analg 2023; 136:43-50. [PMID: 36534716 DOI: 10.1213/ane.0000000000006240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of this study was to evaluate the efficacy of presurgical interventions for promoting smoking cessation in terms of achieving smoking abstinence and reducing surgical complication rates. A systematic review of randomized clinical trials (RCTs) published from March 2009 to April 2021 was performed following the PRISMA guidelines. References were found in MEDLINE (via PubMed), Web of Science (WOS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). RCTs comparing the efficacy of a smoking cessation program directed at an intervention group (IG) versus the usual intervention or another directed at a control group (CG) were included. No language restrictions were applied in the search. All approaches to smoking cessation were admitted (face-to-face, telephone, group, individual, multicomponent, etc.), as were all methods for assessing abstinence, follow-up times, surgical specialties, definitions of smokers, and all types of surgical complications. Four hundred forty-four references were pulled out, and 79 duplicates were discarded. We excluded 346 records that were after application of the inclusion/exclusion criteria. In addition to the remaining 19 articles, 1 article obtained from citation searches was also assessed. We finally included 11 original articles in this systematic review, corresponding to 9 studies, because 2 of the RCTs had 2 different articles referring to different aspects of the same study. The results showed long-term postoperative (6 to 12 months) abstinence rates between 25.0% and 36.4% in RCTs with intensive multicomponent interventions, versus rates about 13.0% in brief interventions. Two multicomponent interventions obtained significant improvements regarding the reduction of short-term postoperative surgical complications. In conclusion, presurgical multicomponent smoking cessation interventions are more effective than brief interventions in terms of achieving abstinence and reducing surgical complications. The follow-up time and the intensity of the interventions were predictors of dropout.
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Affiliation(s)
- Eva Gavilan
- From the Surgical Area, Vall d´Hebron University Hospital, Barcelona, Spain.,International University of Catalonia, Barcelona, Spain.,Multidisciplinary Nursing Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Science, Bellvitge Campus, University of Barcelona, l'Hospitalet de Llobregat, Barcelona, Spain.,CIBER in Respiratory Diseases, Madrid, Spain
| | - Joan Minguell
- Orthopedic Surgery and Traumatology Department, Vall d´Hebron University Hospital, Barcelona, Spain.,School of Medicine and Health Science, Vall d´Hebron Campus, Autonomous University of Barcelona, Barcelona, Spain.,Reconstructive Surgery of the Locomotor System, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Enrique Trilla
- School of Medicine and Health Science, Vall d´Hebron Campus, Autonomous University of Barcelona, Barcelona, Spain.,Urology Department, Vall d´Hebron University Hospital, Barcelona, Spain.,CIBBIM-Nanomedicine, Kidney Phisiopathology Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Management of Knowledge and Evaluation, Vall d´Hebron University Hospital, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Science, Bellvitge Campus, University of Barcelona, l'Hospitalet de Llobregat, Barcelona, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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14
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Phillips LC, Nguyen H, Genge TL, Maddigan WJ. Effectiveness and cost-effectiveness of an intensive and abbreviated individualized smoking cessation program delivered by pharmacists: A pragmatic, mixed-method, randomized trial. Can Pharm J (Ott) 2022; 155:334-344. [PMID: 36386606 PMCID: PMC9647399 DOI: 10.1177/17151635221128263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/27/2022] [Accepted: 07/12/2022] [Indexed: 06/21/2024]
Abstract
BACKGROUND Tobacco use is the leading preventable cause of morbidity and mortality in Canada. Smoking cessation programs (SCPs) that are effective, cost-effective and widely available are needed to help smokers quit. Pharmacists are uniquely positioned to provide such services. This study compares the abstinence rates between 2 pharmacist-led SCPs and the cost-effectiveness between these and a comparator group. The study was conducted in St. John's, Newfoundland and Labrador. METHODS This pragmatic, mixed-method trial randomized smokers to either an existing intensive SCP or a new abbreviated SCP designed for community pharmacies. The primary outcome was 6-month abstinence rates. Cost-effectiveness was determined using abstinence rates for the SCPs and a comparator group. Incremental costs per additional quit were calculated for the trial duration, and incremental costs per life-year gained were estimated over a lifetime. RESULTS Quit rates for the SCPs were 36% (intensive) and 22% (abbreviated) (p = 0.199). Incremental costs per life-year gained for the SCPs were $1576 (intensive) and $1836 (abbreviated). The incremental costs per additional quit, relative to the comparator group, for the SCPs were $1217 (intensive) and $1420 (abbreviated). DISCUSSION Both SCPs helped smokers quit, and quit rates exceeded those reported for a comparator group that included a general population of adult smokers (~7%). The incremental costs per additional quit for both SCPs compare favourably to those reported for other initiatives such as quit lines and hospital-based interventions. CONCLUSION Pharmacist-led smoking cessation programs are effective and highly cost-effective. Widespread implementation, facilitated by remuneration, has potential to lower smoking prevalence and associated costs and harms.
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15
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Alba LH, Peñaloza M, Olejua P, Cespedes E, Cuevas V, Almonacid I, Olaya L, Becerra N. Brief counseling for smoking cessation and alcohol use reduction concomitant with hospital procedures: a randomized clinical trial. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:507-516. [PMID: 36420908 PMCID: PMC9561838 DOI: 10.47626/1516-4446-2021-2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of brief counseling on patient readiness for behavioral change and cessation/reduction of tobacco and alcohol use. METHODS This clinical trial randomized patients in blocks, stratified by risk factor. Adult smokers or at-risk drinkers undergoing surgical or diagnostic procedures were recruited. Outcome assessments and analyses were blinded. Brief counseling was compared with educational materials for the outcomes progress in stage of change and smoking/alcohol cessation/reduction. RESULTS Overall, 222 participants were randomly assigned to the intervention group and 218 to the control group. Among them, 28 and 18 patients were lost to follow-up, respectively. Progress in change stage was 94.1% at 1 month in both groups (RR = 1.00; 95%CI 0.95-1.05) and 94.8 vs. 90.5% at 3 months (RR = 1.05; 95%CI 0.99-1.11) in the intervention and control groups, respectively. Smoking cessation and alcohol reduction rates at 3 months were 57.2 vs. 41% (RR = 1.40; 95%CI 1.14-1.71) in the intervention and control groups, respectively. Only brief counseling led to significant differences in smoking cessation (51.4 vs. 35.1%; RR = 1.46; 95%CI 1.12-1.92). CONCLUSIONS Brief counseling and educational materials improved patient motivation for behavioral change, but brief counseling had a greater effect on smoking cessation.
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Affiliation(s)
- Luz Helena Alba
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia,Servicio de Consulta Externa, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Maylin Peñaloza
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia,Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Peter Olejua
- Oficina de Investigaciones, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Eliana Cespedes
- Programa de Promoción y Prevención, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Virginia Cuevas
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia,Servicio de Consulta Externa, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Ingrid Almonacid
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia,Servicio de Consulta Externa, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Lina Olaya
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia,Servicio de Consulta Externa, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Nelci Becerra
- Javesalud IPS, Bogotá, Colombia,Correspondence: Nelci Becerra, Javesalud IPS, Carrera 19 B # 166-96, Mezzanine, Postal address, 110131, Bogotá, Colombia. E-mail:
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16
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Rigotti NA, Chang Y, Davis EM, Regan S, Levy DE, Ylioja T, Kelley JHK, Notier AE, Gilliam K, Douaihy AB, Singer DE, Tindle HA. Comparative Effectiveness of Postdischarge Smoking Cessation Interventions for Hospital Patients: The Helping HAND 4 Randomized Clinical Trial. JAMA Intern Med 2022; 182:814-824. [PMID: 35759282 PMCID: PMC9237801 DOI: 10.1001/jamainternmed.2022.2300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
IMPORTANCE Smoking cessation interventions for hospitalized patients must continue after discharge to improve long-term tobacco abstinence. How health systems can best deliver postdischarge tobacco treatment is uncertain. OBJECTIVE To determine if health system-based tobacco cessation treatment after hospital discharge produces more long-term tobacco abstinence than referral to a community-based quitline. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted September 2018 to November 2020 in 3 hospitals in Massachusetts, Pennsylvania, and Tennessee. Cigarette smokers admitted to a study hospital who received brief in-hospital tobacco treatment and wanted to quit smoking were recruited for participation and randomized for postdischarge treatment to health system-based Transitional Tobacco Care Management (TTCM) or electronic referral to a community-based quitline (QL). Both multicomponent interventions offered smoking cessation counseling and nicotine replacement therapy (NRT) for up to 3 months. Data were analyzed from February 1, 2021, to April 25, 2022. INTERVENTIONS TTCM provided 8 weeks of NRT at discharge and 7 automated calls with a hospital-based counselor call-back option. The QL intervention sent referrals from the hospital electronic health record to the state quitline, which offered 5 counseling calls and an NRT sample. MAIN OUTCOMES AND MEASURES The main outcome was biochemically verified past 7-day tobacco abstinence at 6 months. Self-reported point-prevalence and continuous tobacco abstinence and tobacco treatment utilization were assessed 1, 3, and 6 months after discharge. RESULTS A total of 1409 participants (mean [SD] age, 51.7 [12.6] years; 784 [55.6%] women; mean [SD] 16.4 [10.6] cigarettes/day) were recruited, including 706 randomized to TTCM and 703 randomized to QL. Participants were comparable at baseline, including 216 Black participants (15.3%), 82 Hispanic participants (5.8%), and 1089 White participants (77.3%). At 1 and 3 months after discharge, more TTCM participants than QL participants used cessation counseling (1 month: 245 participants [34.7%] vs 154 participants [21.9%]; 3 months: 248 participants [35.1%] vs 123 participants [17.5%]; P < .001) and pharmacotherapy (1 month: 455 participants [64.4%] vs 324 participants [46.1%]; 3 months: 367 participants [52.0%] vs 264 participants [37.6%]; P < .001). More TTCM than QL participants reported continuous abstinence for 3 months (RR, 1.30; 95% CI, 1.06-1.58) and point-prevalence abstinence at 1 month (RR, 1.22; 95% CI, 1.08-1.35) and 3 months (RR, 1.23; 95% CI, 1.09-1.37) but not at 6 months (RR, 1.14; 95% CI, 0.99-1.29). The primary outcome, biochemically verified point-prevalence abstinence at 6 months, was not statistically significantly different between groups (19.9% vs 16.9%; RR, 1.18; 95% CI, 0.92-1.50). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, biochemically verified tobacco abstinence rates were not significantly different between groups at the 6-month follow-up. However, the health system-based model was superior to the community-based quitline model throughout the 3 months of active treatment. A longer duration of postdischarge treatment may sustain the superiority of the health system-based model. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03603496.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston.,Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Yuchiao Chang
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Esa M Davis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan Regan
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Douglas E Levy
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston.,Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | | | | | - Anna E Notier
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Karen Gilliam
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Antoine B Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel E Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Hilary A Tindle
- Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research Education and Clinical Centers, Veterans Affairs Tennessee Valley Healthcare System, Nashville
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17
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Burris JL, Borger TN, Baker TB, Bernstein SL, Ostroff JS, Rigotti NA, Joseph AM. Proposing a Model of Proactive Outreach to Advance Clinical Research and Care Delivery for Patients Who Use Tobacco. J Gen Intern Med 2022; 37:2548-2552. [PMID: 35474504 PMCID: PMC9360368 DOI: 10.1007/s11606-022-07553-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
There are evidence-based treatments for tobacco dependence, but inequities exist in the access to and reach of these treatments. Traditional models of tobacco treatment delivery are "reactive" and typically provide treatment only to patients who are highly motivated to quit and seek out tobacco treatment. Newer models involve "proactive" outreach, with benefits that include increasing access to tobacco treatment, prompting quit attempts among patients with low motivation, addressing health disparities, and improving population-level quit rates. However, the definition of "proactive" is not clear, and adoption has been slow. This commentary introduces a comprehensive yet flexible model of proactive outreach and describes how proactive outreach can optimize clinical research and care delivery in these domains: (1) identifying the population, (2) offering treatment, and (3) delivering treatment. Dimensions relevant to each domain are the intensity of proactive outreach (low to high) and the extent to which proactive outreach activities rely on human interaction or are facilitated by information technology (IT). Adoption of the proposed proactive outreach model could improve the precision and rigor with which tobacco cessation research and tobacco treatment programs report data, which could have a positive effect on care delivery and patient outcomes.
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Affiliation(s)
- Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, MB, Boston, USA
| | - Anne M Joseph
- Department of Medicine and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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18
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O'Donnell WJ. Reducing Administrative Harm in Medicine - Clinicians and Administrators Together. N Engl J Med 2022; 386:2429-2432. [PMID: 35731659 DOI: 10.1056/nejmms2202174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Walter J O'Donnell
- From the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, and the Division of Pulmonary and Critical Care Medicine, Harvard Medical School - both in Boston
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19
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Levy DE, Regan S, Perez GK, Muzikansky A, Friedman ER, Rabin J, Rigotti NA, Ostroff JS, Park ER. Cost-effectiveness of Implementing Smoking Cessation Interventions for Patients With Cancer. JAMA Netw Open 2022; 5:e2216362. [PMID: 35679043 PMCID: PMC9185176 DOI: 10.1001/jamanetworkopen.2022.16362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Guidelines recommend cancer care clinicians offer smoking cessation treatment. Cost analyses will help stakeholders understand and plan for implementation of cessation programs. OBJECTIVE To estimate the incremental cost per quit (ICQ) of adopting an intensive smoking cessation intervention among patients undergoing treatment at cancer care clinics, from a clinic perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation, a secondary analysis of the Smokefree Support Study (conducted 2013-2018; completed 2021), used microcosting methods and sensitivity analyses to estimate the ICQ of the interventions. Participants included patients undergoing treatment for a broad range of solid tumors and lymphomas who reported current smoking and were receiving care at cancer care clinics within 2 academic medical centers. EXPOSURES Intensive smoking cessation treatment (up to 11 counseling sessions with free medications), standard of care (up to 4 counseling sessions with medication advice), or usual care (referral to the state quitline). MAIN OUTCOMES AND MEASURES Total costs, component-specific costs, and the ICQ of the intensive smoking cessation treatment relative to both standard of care (comparator in the parent randomized trial) and usual care (a common comparator outside this trial) were calculated. Overall and post hoc site-specific estimates are provided. Because usual care was not included in the parent trial, sensitivity analyses were conducted to assess how assumptions about usual care quit rates affected study outcomes (ie, base case [from a published smoking cessation trial among patients with thoracic cancer], best case, and conservative case scenarios). RESULTS The per-patient costs of offering intensive smoking cessation treatment, standard of care, and usual care were $1989, $1482, and $0, respectively. For intensive treatment, the dominant costs were treatment (35%), staff supervision (26%), and patient enrollment (24%). Relative to standard of care, intensive treatment had an overall ICQ of $3906, and one site had an ICQ of $2892. Relative to usual care, intensive treatment had an ICQ of $9866 overall (base case), although at one site, the ICQ was $5408 (base case) and $3786 (best case). CONCLUSIONS AND RELEVANCE In this economic evaluation study, implementation of an intensive smoking cessation treatment intervention was moderately to highly cost-effective, depending on existing smoking cessation services in place.
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Affiliation(s)
- Douglas E. Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Giselle K. Perez
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Alona Muzikansky
- MGH Biostatistics Center, Massachusetts General Hospital, Boston
| | - Emily R. Friedman
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Julia Rabin
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio
| | - Nancy A. Rigotti
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Jamie S. Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elyse R. Park
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Boston
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20
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Benowitz NL, Liakoni E. Tobacco use disorder and cardiovascular health. Addiction 2022; 117:1128-1138. [PMID: 34590373 DOI: 10.1111/add.15703] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 12/28/2022]
Abstract
This narrative review examines the impact of cigarette smoking and the use of other tobacco and nicotine products on cardiovascular disease. Smoking increases the incidence of both acute and chronic cardiovascular diseases, and the harmful effects are substantially and relatively quickly reversible after quitting. Recommended cessation treatment includes offering pharmacotherapy, counseling which should emphasize the rapid risk reduction that occurs after quitting and adequate follow-up contacts. Although most research on cardiovascular disease in relation to tobacco use has focused upon cigarette smoking, we also review available data related to other combustible tobacco products, smokeless tobacco, electronic nicotine delivery systems and second-hand smoke. We discuss the implications of smoking on clinical management of patients with heart disease and newer developments with potential relevance to treatment of such patients.
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Affiliation(s)
- Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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21
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D'Angelo H, Hohl SD, Rolland B, Adsit RT, Pauk D, Fiore MC, Baker TB. Reach and effectiveness of the NCI Cancer Moonshot-funded Cancer Center Cessation Initiative. Transl Behav Med 2022; 12:688-692. [PMID: 35195268 PMCID: PMC9154282 DOI: 10.1093/tbm/ibac009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Smoking cessation results in improved cancer treatment outcomes. However, the factors associated with successful implementation of cessation programs in cancer care settings are not well understood. This paper presents the reach the reach and effectiveness of cessation programs implemented in NCI-Designated Cancer Centers in the Cancer Center Cessation Initiative (C3I). An observational, cross-sectional study was conducted among C3I Cancer Centers from July 1, 2019 and December 31, 2019 (N = 38). Reach was calculated as the proportion of patients reporting current smoking that received cessation treatment and was analyzed overall and by organizational characteristics. Smoking abstinence rates were determined by the proportion of participants self-reporting smoking abstinence in the previous 7 and 30 days at 6 months after treatment. On average, nearly 30% of patients who smoked received any cessation treatment. In-person counseling was most implemented but reached an average of only 13.2% of patients who smoked. Although less frequently implemented, average reach was highest for counseling provided via an interactive voice response system (55.8%) and telephone-based counseling (18.7%). Reach was higher at centers with more established programs, electronic health record referral systems, and higher smoking prevalence. At 6-month follow-up, about a fifth of participants on average had not smoked in the past 7 days (21.7%) or past 30 days (18.6%). Variations in reach by organizational characteristics suggest that leadership engagement and investment in technology-facilitated programs may yield higher levels of reach. Understanding which implementation and intervention strategies facilitate greater cessation treatment reach and effectiveness could lead to improved outcomes among cancer patients who smoke.
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Affiliation(s)
- Heather D'Angelo
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Sarah D Hohl
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Betsy Rolland
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Danielle Pauk
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael C Fiore
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Timothy B Baker
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
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22
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Yi ZM, Willis S, Zhang Y, Liu N, Tang QY, Zhai SD. Impact of a Collaborative Pharmaceutical Care Service for Patients With Parkinson's Disease. Front Pharmacol 2022; 12:793361. [PMID: 35046815 PMCID: PMC8762333 DOI: 10.3389/fphar.2021.793361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To identify the impact of a collaborative pharmaceutical care service (CPCS) on medication safety and establish the impact of the CPCS on patient reported outcomes for Parkinson's disease (PD) patients. Methods: Initially, PD outpatients receiving the CPCS between March 2017 and March 2019 were compared with PD patients receiving standard of care to identify differences in management. Pharmacist interventions data were coded and patients with PD receiving the CPCS were compared with those receiving standard of care to determine differences in medicines prescribed and dosage associated with these. Following this, data of patients receiving CPCS at baseline and 3-months follow-up were collected using a questionnaire consisting of validated measures of two patient-reported outcomes [adherence and quality of life (QoL)]. Mean scores for continuous variables were calculated, with descriptive analysis of categorical variables consisting of frequency counts and percentages. Change in adherence score before and after CPCS was investigated using a Wilcoxon sign rank sum test, spearman correlation analysis was used to correlate the changes in QoL before and after CPCS with the number of interventions, and p < 0.05 indicates that the difference is statistically significant. Results: A total of 331 PD outpatients received CPCS over 490 outpatient visits with an average age of 71.83 (±12.54). Five hundred and forty-five drug related problems were recorded as pharmacist interventions, of which most involved change to dosage (n = 226, 41.47%), adverse drug reactions (n = 135, 24.77%), and change in a medication (n = 102, 18.72%). Compared with those receiving standard of care, patients receiving CPCS were significantly less likely to have been prescribed pramipexole (18.52 versus 23.77%, p < 0.001) and more likely to have been prescribed amantadine (5.40 versus 3.70%, p = 0.02) and selegiline (17.36 versus 11.64%, p < 0.001). Lower dosages of levodopa/benserazide (0.51 ± 0.31 g versus 0.84 ± 0.37 g, p < 0.001), levodopa/carbidopa (0.33 ± 0.23 g versus 0.66 ± 0.47 g, p < 0.001), pramipexole (1.14 ± 1.63 mg versus 1.27 ± 0.69 mg, p = 0.01), and entacapone (130.00 ± 79.76 mg versus 173.09 ± 97.86 mg, p < 0.001) were also recorded. At baseline 119 PD outpatients with an average age of 69.98 (±9.90) were recruited for the longitudinal study. At 3-month follow-up, participants reported improvement in bodily pain subscale (baseline versus 3-months follow-up, 30.04 ± 22.21 versus 23.01 ± 20.98, p = 0.037) and medication adherence (6.19 ± 1.50 versus 6.72 ± 1.73, p = 0.014). Frequency of CPCS use was related to activity of daily living subscale (p = 0.047), the bodily pain subscale (p = 0.026), and medication adherence (p = 0.011). Total score of PDQ-39 was associated with patient education (p = 0.005) and usage and dosage combined with patient education (p = 0.006), while medication adherence score was associated with usage and dosage (p = 0.005). Conclusion: The CPCS was effective in resolving drug-related problems and in improving patients' medication regimens, medication adherence, and QoL through patient education and dosage adjustments. This is the first step in the development and feasibility testing of pharmacy services for PD patients in China.
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Affiliation(s)
- Zhan-Miao Yi
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Sarah Willis
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Na Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Qi-Yu Tang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Clinical Trials Center, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Suo-Di Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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23
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Neil JM, Marotta C, Gonzalez I, Chang Y, Levy DE, Wint A, Harris K, Hawari S, Noonan E, Styklunas G, Crute S, Howard SE, Sheppard J, Lennes IT, Jacobson F, Flores EJ, Haas JS, Park ER, Rigotti NA. Integrating tobacco treatment into lung cancer screening practices: Study protocol for the Screen ASSIST randomized clinical trial. Contemp Clin Trials 2021; 111:106586. [PMID: 34606988 PMCID: PMC8874354 DOI: 10.1016/j.cct.2021.106586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a 'teachable moment' to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support In Stopping Tobacco) trial, which will identify how to best deliver evidence-driven tobacco treatment in the context of LCS. METHODS Screen ASSIST is a randomized clinical trial with a 3-factor, fully crossed factorial design that enrolls current smokers (any cigarette use in the past 30 days) scheduled to attend LCS at multiple sites in the Mass General Brigham healthcare system. To maximize reach, recruitment is conducted at 3 time points: 1) at the time of LCS scheduling, 2) at the LCS visit, and 3) after the participant has received their LCS results. Participants are stratified by LCS study site and recruitment point and randomly assigned into 8 groups that test intervention components varying on telehealth counseling duration (4 weeks vs. 8 weeks), nicotine replacement therapy duration (2 weeks vs. 8 weeks), and systematic screening and referral for social determinants of health via a service named 'AuntBertha' (referral vs. no referral). The primary study outcome is self-reported past 7-day tobacco abstinence at 6-month follow-up. This trial will also assess systems integration and evaluate implementation of the intervention. DISCUSSION Screen ASSIST will identify the most effective combination of tobacco cessation treatments within the LCS context, in order to improve the cost-effectiveness of LCS and quality of life among long-term heavy smokers.
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Affiliation(s)
- Jordan M Neil
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America; TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States of America; Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Caylin Marotta
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Irina Gonzalez
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Douglas E Levy
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Amy Wint
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kimberly Harris
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Saif Hawari
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Elise Noonan
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Grace Styklunas
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sydney Crute
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sydney E Howard
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Joanne Sheppard
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Inga T Lennes
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Francine Jacobson
- Department of Radiology, Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Efren J Flores
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Jennifer S Haas
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nancy A Rigotti
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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24
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Shoesmith E, Huddlestone L, Lorencatto F, Shahab L, Gilbody S, Ratschen E. Supporting smoking cessation and preventing relapse following a stay in a smoke-free setting: a meta-analysis and investigation of effective behaviour change techniques. Addiction 2021; 116:2978-2994. [PMID: 33620737 DOI: 10.1111/add.15452] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Admission to a smoke-free setting presents a unique opportunity to encourage smokers to quit. However, risk of relapse post-discharge is high, and little is known about effective strategies to support smoking cessation following discharge. We aimed to identify interventions that maintain abstinence following a smoke-free stay and determine their effectiveness, as well as the probable effectiveness of behaviour change techniques (BCTs) used in these interventions. METHODS Systematic review and meta-analyses of studies of adult smokers aged ≥ 18 years who were temporarily or fully abstinent from smoking to comply with institutional smoke-free policies. Institutions included prison, inpatient mental health, substance misuse or acute hospital settings. A Mantel-Haenszel random-effects meta-analysis of randomized controlled trials (RCTs) was conducted using biochemically verified abstinence (7-day point prevalence or continuous abstinence). BCTs were defined as 'promising' in terms of probable effectiveness (if BCT was present in two or more long-term effective interventions) and feasibility (if BCT was also delivered in ≥ 25% of all interventions). RESULTS Thirty-seven studies (intervention n = 9041, control n = 6195) were included: 23 RCTs (intervention n = 6593, control n = 5801); three non-randomized trials (intervention n = 845, control n = 394) and 11 cohort studies (n = 1603). Meta-analysis of biochemically verified abstinence at longest follow-up (4 weeks-18 months) found an overall effect in favour of intervention [risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.08-1.49, I2 = 42%]. Nine BCTs (including 'pharmacological support', 'goal-setting (behaviour)' and 'social support') were characterized as 'promising' in terms of probable effectiveness and feasibility. CONCLUSIONS A systematic review and meta-analyses indicate that behavioural and pharmacological support is effective in maintaining smoking abstinence following a stay in a smoke-free institution. Several behaviour change techniques may help to maintain smoking abstinence up to 18 months post-discharge.
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Affiliation(s)
- Emily Shoesmith
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Lisa Huddlestone
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | | | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Elena Ratschen
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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25
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Brown RA, Minami H, Hecht J, Kahler CW, Price LH, Kjome KL, Bloom EL, Levy DE, Carpenter KM, Smith A, Smits JAJ, Rigotti NA. Sustained Care Smoking Cessation Intervention for Individuals Hospitalized for Psychiatric Disorders: The Helping HAND 3 Randomized Clinical Trial. JAMA Psychiatry 2021; 78:839-847. [PMID: 33950156 PMCID: PMC8100915 DOI: 10.1001/jamapsychiatry.2021.0707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Smoking among individuals with serious mental illness (SMI) represents a major public health problem. Intervening during a psychiatric hospital stay may provide an opportunity to aid engagement in smoking cessation treatment and facilitate success in quitting. OBJECTIVE To examine the effectiveness of a multicomponent, sustained care (SusC) smoking cessation intervention in adults with SMI receiving inpatient psychiatric care. DESIGN, SETTING, AND PARTICIPANTS The Helping HAND 3 randomized clinical trial compared SusC with usual care (UC) among individuals with SMI who smoked daily and were receiving inpatient psychiatric care in Austin, Texas, in a single hospital. The study was conducted from July 2015 through August 2019. INTERVENTIONS The UC intervention involved brief smoking cessation information, self-help materials and advice from the admitting nurse, and an offer to provide nicotine replacement therapy during hospitalization. The SusC intervention included 4 main components designed to facilitate patient engagement with postdischarge smoking cessation resources: (1) inpatient motivational counseling; (2) free transdermal nicotine patches on discharge; (3) an offer of free postdischarge telephone quitline, text-based, and/or web-based smoking cessation counseling, and (4) postdischarge automated interactive voice response calls or text messages. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically verified 7-day point-prevalence abstinence at 6-month follow-up. A secondary outcome was self-reported smoking cessation treatment use at 1, 3, and 6 months after discharge. RESULTS A total of 353 participants were randomized, of whom 342 were included in analyses (mean [SD] age, 35.8 [12.3] years; 268 White individuals [78.4%]; 280 non-Hispanic individuals [81.9%]; 169 women [49.4%]). They reported smoking a mean (SD) of 16.9 (10.4) cigarettes per day. Participants in the SusC group evidenced significantly higher 6-month follow-up point-prevalence abstinence rates than those in the UC group (8.9% vs 3.5%; adjusted odds ratio, 2.95 [95% CI, 1.24-6.99]; P = .01). The number needed to treat was 18.5 (95% CI, 9.6-306.4). A series of sensitivity analyses confirmed effectiveness. Finally, participants in the SusC group were significantly more likely to report using smoking cessation treatment over the 6 months postdischarge compared with participants in the UC group (74.6% vs 40.5%; relative risk, 1.8 [95% CI, 1.51-2.25]; P < .001). CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial provide evidence for the effectiveness of a scalable, multicomponent intervention in promoting smoking cessation treatment use and smoking abstinence in individuals with SMI following hospital discharge. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02204956.
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Affiliation(s)
| | - Haruka Minami
- Department of Psychology, Fordham University, Bronx, New York
| | - Jacki Hecht
- School of Nursing, University of Texas at Austin, Austin
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Lawrence H. Price
- Butler Hospital, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kimberly L. Kjome
- Seton Shoal Creek Hospital, Austin, Texas,Department of Psychiatry, Dell Medical School at the University of Texas at Austin, Austin
| | - Erika Litvin Bloom
- Rhode Island Hospital, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston,Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts Medical School, Harvard Medical School, Boston
| | | | - Ashleigh Smith
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin,Department of Health Social Work, Steve Hicks School of Social Work, University of Texas at Austin, Austin
| | | | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston
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Howard R, Albright J, Osborne N, Englesbe M, Goodney P, Henke P. Impact of a regional smoking cessation intervention for vascular surgery patients. J Vasc Surg 2021; 75:262-269. [PMID: 34298118 DOI: 10.1016/j.jvs.2021.07.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tobacco use is common among vascular surgery patients and negatively impacts outcomes and longevity. In the second quarter of 2018, a statewide vascular quality collaborative launched an initiative across its 35 participating hospitals to promote smoking cessation at the time of surgery. This intervention was based on the Vascular Physician Offer and Report (VAPOR) trial and consisted of 3 components: brief physician-delivered advice, referral to telephone-based counseling, and nicotine replacement therapy. The goal of this study is to evaluate the results of this intervention. METHODS We performed a retrospective analysis of patients undergoing vascular surgery between 2018 and 2020. Procedures included open abdominal aortic aneurysm repair, endovascular aneurysm repair, open vascular bypass, open thrombectomy, carotid endarterectomy, and carotid stenting. The primary explanatory variables were receipt of tobacco cessation interventions as documented in the medical record. The primary outcome was tobacco cessation, captured during 30-day and 1-year chart review and/or patient follow-up. A multivariable logistic regression model was calculated to estimate the association of covariates with smoking cessation while adjusting for patient and clinical characteristics. RESULTS A total of 13,890 patients underwent surgery during the study period. The mean age was 69.4 ± 10 years; 4687 patients (34%) were female, and 5158 patients (37%) were current smokers. At least one smoking cessation component was delivered to 2245 patients (44% of smokers). The quit rate was 35% among 4671 patients with 30-day follow-up and 43% among 2936 patients with 1-year follow up. On multivariable regression, at 30 days, receiving two intervention components was associated with 1.29 (95% confidence interval [CI], 1.07-1.55) higher odds of quitting. At both time points, smoking cessation was also associated with undergoing an emergent procedure (30-day odds ratio [OR], 1.52; 95% CI, 1.16-1.99; 1-year OR, 1.41; 95% CI, 1.01-1.97) and undergoing open abdominal aortic aneurysm repair (30-day OR, 1.71; 95% CI, 1.20-2.43; 1-year OR, 1.75; 95% CI, 1.11-2.78). CONCLUSIONS In a cohort of vascular surgical patients where tobacco use was common, nearly one-half of patients quit smoking 1 year after surgery. Receiving two smoking cessation intervention components was associated with quitting at 30 days. Overall, these results demonstrate encouraging quit rates and identify an opportunity for longer-term intervention to maintain even greater 1-year tobacco cessation.
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Affiliation(s)
- Ryan Howard
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Jeremy Albright
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Mich
| | - Nicholas Osborne
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | | | - Philip Goodney
- Section of Vascular Surgery and the Dartmouth Institute, Dartmouth-Hitchcock Medical Center, Dartmouth, Lebanon, NH
| | - Peter Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
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Suñer-Soler R, Grau-Martín A, Terceño M, Silva Y, Maldonado E, Gras ME, Font-Mayolas S, Rodrigo-Gil J, Serena J. A clinical trial comparing smoking cessation interventions at two levels of intensity in stroke patients, stratified by the presence of insular cortex lesions. Nicotine Tob Res 2021; 24:44-52. [PMID: 34245288 DOI: 10.1093/ntr/ntab144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/09/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Smoking is a stroke risk factor but the most efficient way to promote cessation is unknown. The smoking behavior in patients during the first 2 years post-stroke is studied comparing brief advice and intensive behavioral counseling interventions, taking into consideration biological, psychological, and social factors. METHODS Randomized clinical trial of 196 stroke patients, stratified by the presence or not of an insular cortex lesion, with two levels of smoking cessation intervention. RESULTS The study retention rate was 85.2%. Abstinence point prevalence at three months after stroke was 50% in the brief advice group and 51.7% in the intensive behavioral counseling group (p =.82) and at 24 months, 48.3% in the brief group and 47.5% in the intensive group (p =.92). Most relapses occurred in the first weeks. After 3 months the curves separated with fewer events in the intensive group and at 24 months the Hazard Ratio was 0.91 (95% CI = 0.61 to 1.37; p =.67).Twenty-four months after stroke, patients with an insular lesion were more likely to be abstinent (OR 3.60, 95% CI = 1.27 to 10.14), as were those who lived with a partner (OR 2.31, 95% CI = 1.17 to 4.55) and those who were less dependent (OR 0.84, 95% CI = 0.73 to 0.97). CONCLUSIONS A high percentage of patients gave up smoking in both intervention groups with no significant differences between the two. The effect of the insular lesion on smoking cessation, which is early and continued after two years, is particularly notable.
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Affiliation(s)
- Rosa Suñer-Soler
- Department of Nursing and Health and Health Care Research Group, University of Girona, Girona, Catalonia, Spain
| | - Armand Grau-Martín
- Fundació Salut Empordà, Figueres Hospital and Quality of Life Research Institute, University of Girona, Catalonia, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Catalonia, Spain
| | - Yolanda Silva
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Catalonia, Spain
| | | | - Maria Eugenia Gras
- Quality of Life Research Institute, University of Girona, Catalonia, Spain
| | | | - Joana Rodrigo-Gil
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Catalonia, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Catalonia, Spain
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Matuszewski PE, Joseph K, O'Hara NN, DiClemente C, O'Toole RV. Prospective Randomized Trial on Smoking Cessation in Orthopaedic Trauma Patients: Results From the Let's STOP (Smoking in Trauma Orthopaedic Patients) Now Trial. J Orthop Trauma 2021; 35:345-351. [PMID: 33252440 DOI: 10.1097/bot.0000000000002028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Determine if extended inpatient counseling increases smoking cessation. DESIGN Prospective randomized trial. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Current smokers with an operative fracture. INTERVENTION Randomly assigned to control (no counseling), brief counseling (inpatient counseling), or extended counseling (brief counseling plus follow-up counseling) groups in a 1:3:3 ratio. MAIN OUTCOME MEASUREMENTS Smoking cessation confirmed by exhaled carbon monoxide at 3 and 6 months. Secondary outcomes are proportion accepting services from a nationally based quitline. RESULTS Overall, 266 patients participated, with 40, 111, and 115 patients in the control and 2 treatment groups, respectively. At 3 months, 17% of control patients versus 11% in the brief counseling and 10% in the extended counseling groups quit smoking, respectively (P = 0.45, 0.37). At 6 months, 15% of control, and 10% and 5% of the respective counseling groups quit (P = 0.45, 0.10). Extended counseling patients were 3 times more likely to accept referral to a quitline [odds ratio (OR), 3.1; 95% confidence interval (CI), 1.4-6.9], and brief counseling patients were more than 2 times as likely to accept referral (OR, 2.3; 95% CI, 1.0-5.1) than the control group. Extended counseling (OR, 8.2; 95% CI, 1.0-68.5) and brief counseling (OR, 5.3; 95% CI, 0.6-44.9) patients were more likely to use quitline services than the control group. CONCLUSION Increasing levels of inpatient counseling can improve successful referral to a smoking quitline, but it does not seem to influence quit rates among orthopaedic trauma patients. Extended counseling does not appear to provide substantial benefit over brief counseling. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paul E Matuszewski
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky School of Medicine, Lexington, KY
| | | | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and
| | | | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and
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Salloum RG, LeLaurin JH, Dallery J, Childs K, Huo J, Shenkman EA, Warren GW. Cost evaluation of tobacco control interventions in clinical settings: A systematic review. Prev Med 2021; 146:106469. [PMID: 33639182 DOI: 10.1016/j.ypmed.2021.106469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 11/22/2022]
Abstract
Elucidating the cost implications of tobacco control interventions is a prerequisite to their adoption in clinical settings. This review fills a knowledge gap in characterizing the extent to which cost is measured in tobacco control studies. A search of English literature was conducted in the following electronic databases: MEDLINE, EconLit, PsychINFO, and CINAHL using MeSH terms from 2009 to 2018. Studies were reviewed by two independent reviewers and included if they were conducted in U.S. inpatient or outpatient facilities and reported costs associated with a tobacco control intervention. They were categorized according to evaluation type, clinical setting, target population, cost measures, and stakeholder perspective. Bias risk was evaluated for RCTs. Seventeen publications were included, representing counseling interventions (n = 8) and combination (i.e., counseling and pharmacotherapy) interventions (n = 9). Studies were categorized by evaluation type: cost-effectiveness analysis (n = 10), cost utility analysis (n = 3) and cost identification (n = 4). The selected studies targeted the following populations: general adults (n = 6), hospitalized/inpatient (n = 4), military/veterans (n = 4), individuals with low socioeconomic status (n = 4), mental health or medical comorbidities (n = 2), and pregnant women (n = 2). Intervention costs included personnel, medication, education material, technology, and overhead costs. Stakeholder perspectives included: healthcare organization (n = 10), payer (n = 8), patient (n = 2), and societal (n = 1). Few studies have reported the cost of tobacco control interventions in clinical settings. Cost is a critical outcome that should be consistently measured in evaluations of tobacco control interventions to promote their uptake in clinical settings.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Kayla Childs
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jinhai Huo
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Graham W Warren
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA; Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
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Garey L, Wirtz MR, Labbe AK, Zvolensky MJ, Smits JAJ, Giordano TP, Rosenfield D, Robbins GK, Levy DE, McKetchnie SM, Bell T, O'Cleirigh C. Evaluation of an integrated treatment to address smoking cessation and anxiety/depressive symptoms among people living with HIV: Study protocol for a randomized controlled trial. Contemp Clin Trials 2021; 106:106420. [PMID: 33933667 PMCID: PMC10080995 DOI: 10.1016/j.cct.2021.106420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Interventions that target anxiety/depressive symptoms in the context of smoking treatment have shown promise irrespective of psychiatric diagnosis. Yet, these tailored treatments are largely absent for persons who smoke and are living with HIV (SLWH). OBJECTIVE To evaluate a novel, smoking cessation intervention that addresses anxiety/depression and HIV-related health (QUIT) against a time-matched control (TMC) and a standard of care (SOC) condition. METHODS SLWH (N = 180) will be recruited and enrolled from 3 medical clinics in Boston, MA, and Houston, TX. The trial will consist of a baseline assessment, a 10-week intervention/assessment period, and follow-up assessments, accounting for a total study duration of approximately 8 months. All participants will complete a baseline visit and a pre-randomization standardized psychoeducation visit, and will then be randomized to one of three conditions: QUIT, TMC, or SOC. QUIT and TMC will consist of nine 60-min, cognitive behavioral therapy-based, individual weekly counseling sessions using standard smoking cessation counseling; additionally, QUIT will target anxiety and depressive symptoms by addressing underlying mechanisms related to mood and quit difficulty. SOC participants will complete weekly self-report surveys for nine weeks. All participants will be encouraged to quit at Session 7 and will be offered nicotine replacement therapy to help. CONCLUSIONS QUIT is designed to improve smoking cessation in SLWH by addressing anxiety and depression and HIV-related health issues. If successful, the QUIT intervention would be ready for implementation and dissemination into "real-world" behavioral health and social service settings consistent with the four objectives outlined in NIDA's Strategic Plan.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Megan R Wirtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Allison K Labbe
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, United States of America
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, United States of America
| | - Gregory K Robbins
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Samantha M McKetchnie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; The Fenway Institute, Fenway Health, Boston, MA, United States of America
| | - Tanisha Bell
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Fenway Health, Boston, MA, United States of America.
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Smoking Cessation and Hospitalized Patients: A Missed Opportunity to Avoid Premature Deaths. Ochsner J 2021; 21:10-13. [PMID: 33828420 PMCID: PMC7993432 DOI: 10.31486/toj.20.0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Williams BS, Smith SS, Marbin JN, Huang MZ, Garell CL, Kosack AS, Shaikh U, Tebb KP, Fiore MC. Addressing Environmental Smoke Exposure During Pediatric Hospitalization: Attitudes and Practices of Pediatric Nurses Versus Respiratory Therapists. Respir Care 2021; 66:275-280. [PMID: 32962999 PMCID: PMC9994221 DOI: 10.4187/respcare.08038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Tobacco smoke exposure leads to numerous adverse health effects in children. Providing cessation interventions to caregivers who smoke during pediatric hospitalizations can help protect children from such exposure. Both pediatric registered nurses (RNs) and pediatric respiratory therapists (RTs) are well positioned to provide these interventions. Little is known about their rates of participation in cessation efforts. Our objective was to compare the attitudes and practice of pediatric RNs versus pediatric RTs to evaluate their relative cessation-intervention practices in the in-patient pediatric setting. METHODS An online survey was sent to pediatric RNs and RTs at 4 tertiary pediatric hospitals in California. The survey assessed individual demographics, work environment, experience, beliefs, and practices related to smoking cessation activities. Questions used 3-point and 5-point Likert scales and were compared with the chi-square test. Institutions with a response rate < 20% were excluded. RESULTS A total of 401 respondents were included in the final analysis (292 RNs, 109 RTs). RTs versus RNs were older (42.0 y vs 35.4 y, respectively, P < .001) and more likely to be former smokers (29.9% vs 13.3%, respectively, P < .001). RNs reported lower levels of confidence in discussing smoking cessation with parents, with 11.7% saying they felt "very confident" compared to 29.0% of RTs (P < .001). RNs also reported screening for smoke exposure less frequently than RTs, with 18.8% responding "often" or "always" compared to 28.9% of RTs (P = .033). RNs had lower rates of advising parents "to make a smoke-free home policy" compared to RTs (ie, 13.4% vs 26.9%, respectively, P = .002). CONCLUSIONS Compared to in-patient pediatric RNs, RTs reported higher rates of confidence in providing cessation interventions, screening for smoke exposure, and counseling on reducing smoke exposure, suggesting that they may be better positioned for intervening. These results can inform the design of an in-patient cessation intervention for caregivers of hospitalized children.
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Affiliation(s)
- Brian S Williams
- Department of Pediatrics and Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Stevens S Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jyothi N Marbin
- Department of Pediatrics, UCSF School of Medicine, San Francisco, California
| | - Maria Z Huang
- Department of Pediatrics, UC-San Diego School of Medicine, San Diego, California
| | - Cambria L Garell
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amanda S Kosack
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ulfat Shaikh
- Department of Pediatrics, UC-Davis School of Medicine, Sacramento, California
| | - Kathleen P Tebb
- Department of Pediatrics, UCSF School of Medicine, San Francisco, California
| | - Michael C Fiore
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Piper ME, Bullen C, Krishnan-Sarin S, Rigotti NA, Steinberg ML, Streck JM, Joseph AM. Defining and Measuring Abstinence in Clinical Trials of Smoking Cessation Interventions: An Updated Review. Nicotine Tob Res 2020; 22:1098-1106. [PMID: 31271211 DOI: 10.1093/ntr/ntz110] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/02/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Changes in tobacco products, use patterns, and assessment technology in the last 15 years led the Society for Research on Nicotine and Tobacco (SRNT) Treatment Research Network to call for an update to the 2003 SRNT recommendations for assessing abstinence in clinical trials of smoking cessation interventions. METHODS The SRNT Treatment Research Network convened a group of investigators with decades of experience in conducting tobacco treatment clinical trials. To arrive at the updated recommendations, the authors reviewed the recommendations of the prior SRNT Workgroup as well as current literature. Ten additional experts in the field provided feedback on this paper and these recommendations. RESULTS With respect to defining abstinence, the authors recommend: (1) continuing to use the definition of no use of combustible tobacco products (regardless of use of noncombustible tobacco products [e.g., snus] and alternative products [e.g., e-cigarettes]) and collecting additional data to permit alternate abstinence definitions; (2) no use of combustible or smokeless tobacco products; and (3) no use of combustible or smokeless tobacco products or alternative products, as appropriate for the research question being addressed. The authors also recommend reporting point prevalence and prolonged abstinence at multiple timepoints (end of treatment, ≥3 months after the end of treatment, and ≥6 months postquit or posttreatment initiation). CONCLUSIONS Defining abstinence requires specification of which products a user must abstain from using, the type of abstinence (i.e., point prevalence or continuous), and the duration of abstinence. These recommendations are intended to serve as guidelines for investigators as they collect the necessary data to accurately describe participants' abstinence during smoking cessation clinical trials. IMPLICATIONS This paper provides updated recommendations for defining abstinence in the context of smoking cessation treatment clinical trials.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention of Wisconsin, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Marc L Steinberg
- Division of Addiction Psychiatry, Rutgers University, New Brunswick, NJ
| | - Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anne M Joseph
- Department of Medicine, University of Minnesota, Minneapolis, MN
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Pham J, Pitney S, Sweeney D, Reekie C, Harkness N. Poor initiation of smoking cessation therapies in hospitalised patients with chronic obstructive pulmonary disease is associated with low levels of formal training among hospital doctors and under‐utilisation of nursing‐led interventions. Intern Med J 2020; 50:1384-1389. [DOI: 10.1111/imj.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/11/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan Pham
- Royal Hobart Hospital Hobart Tasmania Australia
- University of Tasmania Hobart Tasmania Australia
| | | | | | | | - Nick Harkness
- Royal Hobart Hospital Hobart Tasmania Australia
- University of Tasmania Hobart Tasmania Australia
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Tran Luy M, Le Faou AL, Airagnes G, Limosin F. [Systematic identification of smokers and tobacco smoking management in the general hospital]. Rev Mal Respir 2020; 37:644-651. [PMID: 32883549 DOI: 10.1016/j.rmr.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The prevalence of daily smoking in France was 24 % in 2019 and tobacco control remains a major public health issue. A hospital stay provides an opportunity for smoking cessation intervention. Identification and management of smokers during a hospital stay may be variously integrated into electronic health records (EHR). STATE OF THE ART Smoking status identification, which have included pre-filled forms, check-box, reminders, icons, is heterogeneous. Specific modules in EHR have been implemented for smoking cessation management such as counselling sessions, tobacco cessation prescriptions, smoking cessation guidelines and long-term follow-up. EHR-based intervention to identify and manage smokers with a long-term follow-up for at least one month after hospital discharge has shown an increase in smoking abstinence at 6-12 months. OUTLOOK Due to the lower quality of free data about smoking status, systematic identification with check-box, reminders or icons in EHR may be more appropriate. Integration of functionalities such as help for prescription, reminders and follow-up of patients would make tobacco cessation management easier for health professionals. CONCLUSION EHR interventions to identify smokers and manage smoking cessation during hospital stays are an opportunity to increase smoking cessation.
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Affiliation(s)
- M Tran Luy
- DMU psychiatrie et addictologie, Centre-Université de Paris, AP-HP, France.
| | - A-L Le Faou
- DMU psychiatrie et addictologie, Centre-Université de Paris, AP-HP, France
| | - G Airagnes
- DMU psychiatrie et addictologie, Centre-Université de Paris, AP-HP, France; Population-based epidemiologic Cohorts, UMS 011, inserm, France
| | - F Limosin
- DMU psychiatrie et addictologie, Centre-Université de Paris, AP-HP, France; Centre psychiatrie et neurosciences, U894, inserm, France
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Amaral LMD, Macêdo ÂCDADD, Lanzieri IO, Andrade RDO, Richter KP, Leite ICG. Promoting cessation in hospitalized smoking patients: a systematic review. ACTA ACUST UNITED AC 2020; 66:849-860. [PMID: 32696879 DOI: 10.1590/1806-9282.66.6.849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/08/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this review was to evaluate high intensity post-discharge follow-up strategies to promote smoking cessation in hospitalized patients. METHODS A systematic review was performed, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA - P) protocol. The databases used for research were: PubMed, LILACS/BIREME, Scopus, Web of Science, Cochrane and Scielo. The included articles were randomized clinical trials, published from 1990 to 2018, which evaluated in-hospital and post-discharge intervention, and provided a minimum of 30-day care post discharge. The studies aimed to evaluate tobacco cessation. RESULTS Fourteen studies were selected for analysis. Across studies, pharmacotherapy was consistently effective for smoking cessation. Communication technologies likewise were consistently effective for cessation and post-discharge access. CONCLUSION Effective strategies exist. The challenge for future trials is to determine the best approaches for different clinical contexts, to promote cessation.
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Affiliation(s)
- Lígia Menezes do Amaral
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | | | | | | | - Kimber P Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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See JJH, See KC. Impact of Admission Diagnosis on the Smoking Cessation Rate: A Brief Report From a Multi-centre Inpatient Smoking Cessation Programme in Singapore. J Prev Med Public Health 2020; 53:381-386. [PMID: 33070510 PMCID: PMC7569012 DOI: 10.3961/jpmph.20.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/23/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives Few studies have been published regarding the relevance of the admission diagnosis to the smoking cessation rate. We studied smoking cessation rates in relation to admission diagnoses in our inpatient smoking cessation programmes. Methods This retrospective study included all patients recruited into our inpatient smoking cessation programmes at 2 institutions in Singapore between June 2008 and December 2016. Patients were given individualized intensive counselling and were followed up via phone interviews for up to 6-month to assess their smoking status. Multivariable logistic regression was used to analyse potential associations between admission diagnoses and 6-month abstinence. Results A total of 7194 patients were included in this study. The mean age was 54.1 years, and 93.2% were male. In total, 1778 patients (24.7%) were abstinent at the 6-month follow-up call. Patients who quit smoking tended to be of Chinese ethnicity, have initiated smoking at a later age, be better educated, and have lower Fagerström Test of Nicotine Dependence scores. After adjusting for these factors, patients with a cardiovascular admission diagnosis had a significantly higher probability of quitting tobacco use than patients with a respiratory or other diagnosis. Conclusions In patients acutely admitted to the hospital, a diagnosis of cardiovascular disease was associated with the highest quit rate. Smoking cessation interventions need to be incorporated into all cardiovascular disease treatment pathways to leverage the patient’s motivation and to improve the quit rate. In addition, patients in groups with lower quit rates may benefit from more intensive programmes to increase the rate of successful cessation.
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Affiliation(s)
| | - Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
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Rigotti NA, Schnitzer K, Davis EM, Regan S, Chang Y, Kelley JHK, Notier AE, Gilliam K, Douaihy A, Levy DE, Singer DE, Tindle HA. Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping HAND 4 randomized controlled trial. Trials 2020; 21:336. [PMID: 32299470 PMCID: PMC7164139 DOI: 10.1186/s13063-020-04257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/14/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tobacco smoking remains the leading preventable cause of death in the US. A hospital admission provides smokers with a unique opportunity to stop smoking because it requires temporary tobacco abstinence while illness may enhance motivation to quit. Hospital interventions must continue post-discharge to increase tobacco abstinence long-term, but how best to accomplish this remains unclear. Building on two previous randomized controlled trials, each of which tested smoking cessation interventions that began in hospital and continued after discharge, this trial compares two interventions that provide sustained smoking cessation treatment after hospital discharge with the goal of improving long-term smoking cessation rates among hospitalized smokers. METHODS/DESIGN Helping HAND 4 is a three-site randomized controlled trial that compares the effectiveness of two active interventions for producing validated past 7-day tobacco abstinence 6 months after hospital discharge. Smokers who are admitted to three hospitals receive a standard in-hospital smoking intervention, and those who plan to quit smoking after discharge are recruited and randomly assigned to two interventions that begin at discharge, Personalized Tobacco Care Management (PTCM) or Quitline eReferral. Each lasts 3 months. At discharge, PTCM provides 8 weeks of free nicotine replacement (NRT; a participant's choice of patch, gum, lozenge, or a combination) and then proactive smoking cessation support using an automated communication platform and live contact with a tobacco treatment specialist who is based in the health care system. In the eReferral condition, a direct referral is made from the hospital electronic health record to a community-based resource, the state's telephone quitline. The quitline provides up to 8 weeks of free NRT and offers behavioral support via a series of phone calls from a trained coach. Outcomes are assessed at 1, 3, and 6 months after discharge. The study hypothesis is that PTCM will produce higher quit rates than eReferral. DISCUSSION Helping HAND 4 is a pragmatic trial that aims to evaluate interventions in real-world conditions. This project will give hospital systems critical evidence-based tools for meeting National Hospital Quality Measures for tobacco treatment and maximizing their ability to improve cessation rates and overall health for the millions of smokers hospitalized annually in the US. TRIAL REGISTRATION Prospectively registered prior to start of enrollment at Clinicaltrials.gov, NCT03603496 (July 27, 2018). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00084MJ&selectaction=Edit&uid=U00002G7&ts=2&cx=ff0oxn.
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Affiliation(s)
- Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Kristina Schnitzer
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Esa M. Davis
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Jennifer H. K. Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
| | - Anna E. Notier
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Karen Gilliam
- Vanderbilt University Medical Center, Nashville, TN USA
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Daniel E. Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Hilary A. Tindle
- Vanderbilt University Medical Center, Nashville, TN USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN USA
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Kruse GR, Thawal V, Gupte HA, Chaudhuri L, Pradhan S, Howard S, Rigotti NA. Tobacco Use and Subsequent Cessation Among Hospitalized Patients in Mumbai, India: A Longitudinal Study. Nicotine Tob Res 2020; 22:363-370. [PMID: 30778542 DOI: 10.1093/ntr/ntz026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/14/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Hospitalization is an important setting to address tobacco use. Little is known about post-discharge cessation and treatment use in low- and middle-income countries. Our objective was to assess tobacco use after hospital discharge among patients in Mumbai, India. METHODS Longitudinal observational study of inpatients (≥15 years) admitted at one hospital from November 2015 to October 2016. Patients reporting current tobacco use were surveyed by telephone after discharge. RESULTS Of 2894 inpatients approached, 2776 participated and 15.7% (N = 437) reported current tobacco use, including 5.3% (N = 147) smokers, 9.1% (N = 252) smokeless tobacco (SLT) users, and 1.4% (N = 38) dual users. Excluding dual users, SLT users, compared to smokers, were less likely to report a plan to quit after discharge (42.6% vs. 54.2%, p = .04), a past-year quit attempt (38.1% vs. 52.7%, p = .004), to agree that tobacco has harmed them (57.9% vs. 70.3%, p = .02) or caused their hospitalization (43.4% vs. 61.4%, p < .001). After discharge, 77.6% of smokers and 78.6% of SLT users reported trying to quit (p = .81). Six-month continuous abstinence after discharge was reported by 27.2% of smokers and 24.6% of SLT users (p = .56). Nearly all relapses to tobacco use after discharge occurred within 30 days and did not differ by tobacco type (log-rank p = .08). Use of evidence-based cessation treatment was reported by 6.5% (N = 26). CONCLUSIONS Three-quarters of tobacco users in a Mumbai hospital attempted to quit after discharge. One-quarter reported continuous tobacco abstinence for 6 months despite little use of cessation treatment. Increasing post-discharge cessation support could further increase cessation rates and improve patient outcomes. IMPLICATIONS No prior study has measured the patterns of tobacco use and cessation among hospitalized tobacco users in India. Three-quarters of tobacco users admitted to a hospital in Mumbai attempted to quit after discharge, and one-quarter remained tobacco-free for 6 months, indicating that hospitalization may be an opportune time to offer a cessation intervention. Although smokers and SLT users differed in socioeconomic status, perceived risks and interest in quitting, they did not differ in their ability to stay abstinent after hospital discharge.
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Affiliation(s)
- Gina R Kruse
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | | | | | - Sydney Howard
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Gonzales D, Bjornson WG, Markin CJ, Coleman TM, Favela F, Clemons N, Koudelka C, Lapidus JA. Improving Smoking Cessation Outcomes Through Tailored-Risk Patient Messages at a University Hospital Tobacco Cessation Service. Jt Comm J Qual Patient Saf 2020; 46:250-260. [PMID: 32362354 DOI: 10.1016/j.jcjq.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/02/2020] [Accepted: 02/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postdischarge follow-up is a critical step for increasing effectiveness of hospital smoking cessation treatment. A quality improvement project was undertaken at an academic medical center tobacco cessation consult service to evaluate whether a tailored message (TM) linking immediate risks of continued smoking-particularly carbon monoxide exposure-to hospital recovery would stimulate more patient interest in the hospital's cessation treatment, including agreement to postdischarge follow-up, compared to patients receiving the usual treatment protocol with a standard message (SM) regarding more general health benefits of abstinence. METHODS Data from 697 smokers ordered/referred for smoking cessation treatment in 2013 who received either the SM (January-April; n = 323) or the TM (April-November; n =374) were analyzed. RESULTS Multivariate regression analysis showed that the TM was associated with significantly greater agreement for follow-up (odds ratio [OR] = 10.83, 95% confidence interval [CI] = 3.66-32.04, p < 0.0001) than the SM. Those patients who received the TM were more willing to try to remain abstinent postdischarge (willingness score = 10, p = 0.0052) and engaged in longer consults (consult time > 10 minutes, p = 0.0075) than SM patients. TM patients also self-reported a higher continuous abstinence rate (OR = 2.07, 95% CI = 1.17-3.66, p = 0.0130] at follow-up than SM. CONCLUSION Linking risks of continued smoking, particularly carbon monoxide exposure, to hospital patients' immediate recovery following discharge in a treatment protocol resulted in longer consult times and increased agreement to follow-up compared to the usual protocol message. The TM was integrated into the hospital tobacco cessation intervention as standard of care.
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Ellerbeck EF, Cox LS, Hui SKA, Keighley J, Hutcheson TD, Fitzgerald SA, Cupertino AP, Greiner KA, Rigotti NA, Miller NH, Rabius V, Richter KP. Impact of Adding Telephone-Based Care Coordination to Standard Telephone-Based Smoking Cessation Counseling Post-hospital Discharge: a Randomized Controlled Trial. J Gen Intern Med 2019; 34:2804-2811. [PMID: 31367875 PMCID: PMC6854179 DOI: 10.1007/s11606-019-05220-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cessation counseling and pharmacotherapy are recommended for hospitalized smokers, but better coordination between cessation counselors and providers might improve utilization of pharmacotherapy and enhance smoking cessation. OBJECTIVE To compare smoking cessation counseling combined with care coordination post-hospitalization to counseling alone on uptake of pharmacotherapy and smoking cessation. DESIGN Unblinded, randomized clinical trial PARTICIPANTS: Hospitalized smokers referred from primarily rural hospitals INTERVENTIONS: Counseling only (C) consisted of telephone counseling provided during the hospitalization and post-discharge. Counseling with care coordination (CCC) provided similar counseling supplemented by feedback to the smoker's health care team and help for the smoker in obtaining pharmacotherapy. At 6 months post-hospitalization, persistent smokers were re-engaged with either CCC or C. MAIN MEASURES Utilization of pharmacotherapy and smoking cessation at 3, 6, and 12 months post-discharge. KEY RESULTS Among 606 smokers randomized, 429 (70.8%) completed the 12-month assessment and 580 (95.7%) were included in the primary analysis. Use of any cessation pharmacotherapy between 0 and 6 months (55.2%) and between 6 and 12 months (47.1%) post-discharge was similar across treatment arms though use of prescription-only pharmacotherapy between months 6-12 was significantly higher in the CCC group (30.1%) compared with the C group (18.6%) (RR, 1.61 (95% CI, 1.08, 2.41)). Self-reported abstinence rates of 26.2%, 20.3%, and 23.4% at months 3, 6, and 12, respectively, were comparable across the two treatment arms. Of those smoking at month 6, 12.5% reported abstinence at month 12. Validated smoking cessation at 12 months was 19.3% versus 16.9% in the CCC and C groups, respectively (RR, 1.13 (95% CI, 0.80, 1.61)). CONCLUSION Supplemental care coordination, provided by counselors outside of the health care team, failed to improve smoking cessation beyond that achieved by cessation counseling alone. Re-engagement of smokers 6 months post-discharge can lead to new quitters, at which time care coordination might facilitate use of prescription medications. TRIAL REGISTRATION NCT01063972.
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Affiliation(s)
- Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA.
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
| | | | - John Keighley
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tresza D Hutcheson
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
| | - Sharon A Fitzgerald
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
| | - A Paula Cupertino
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Vance Rabius
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kimber P Richter
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1008, Kansas City, KS, 66160, USA
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Thorley R, Britton J, Nyakutsikwa B, Opazo Breton M, Lewis SA, Murray RL. Enhanced smoking cessation support for newly abstinent smokers discharged from hospital (the Hospital to Home trial): a randomized controlled trial. Addiction 2019; 114:2037-2047. [PMID: 31240811 DOI: 10.1111/add.14720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 06/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The United Kingdom's National Institute for Health and Care Excellence guidance (NICE PH48) recommends that pharmacotherapy combined with behavioural support be provided for all smokers admitted to hospital; however, relapse to smoking after discharge remains common. This study aimed to assess the effect of adding home support for newly abstinent smokers to conventional NICE-recommended support in smokers discharged from hospital. DESIGN Individually randomized parallel group trial. SETTING One UK acute hospital. PARTICIPANTS A total of 404 smokers aged > 18 admitted to acute medical wards between June 2016 and July 2017 were randomized in equal numbers to each treatment group. INTERVENTIONS AND COMPARATORS The intervention provided 12 weeks of at-home cessation support, which included help in maintaining a smoke-free home, help in accessing and using medication, further behavioural support and personalized feedback on home air quality. The comparator was NICE PH48 care as usual. MEASURES The primary outcome was self-reported continuous abstinence from smoking validated by an exhaled carbon monoxide level < 6 parts per million 4 weeks after discharge from hospital. FINDINGS In an intention-to-treat analysis at the 4-week primary end-point, 38 participants (18.8%) in the usual care group and 43 (21.3%) in the intervention group reported continuous abstinence from smoking (odds ratio = 1.17, 95% confidence interval = 0.72 to 1.90, Bayes factor = 0.33). There were no significant differences in any secondary outcomes, including self-reported cessation at 3 months, having a smoke-free home or number of cigarettes smoked per day in those who did not quit. CONCLUSIONS Provision of a home visit and continued support to prevent relapse to smoking after hospital discharge did not appear to increase subsequent abstinence rate above usual care in accordance with UK guidance from the National Institute of Health and Care Excellence.
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Affiliation(s)
- Rebecca Thorley
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
| | - John Britton
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
| | - Blessing Nyakutsikwa
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
| | - Magdalena Opazo Breton
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
| | - Sarah A Lewis
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
| | - Rachael L Murray
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, UK
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Patient and Physician Perspectives on Treating Tobacco Dependence in Hospitalized Smokers With Substance Use Disorders: A Mixed Methods Study. J Addict Med 2019; 13:338-345. [DOI: 10.1097/adm.0000000000000503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A Longitudinal Curriculum for Teaching Evidence-Based Medicine to Physician Assistant Students Using Shapes and POEMs. J Physician Assist Educ 2019; 30:178-183. [PMID: 31433367 DOI: 10.1097/jpa.0000000000000269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The relationship between health-related variables and increases in smoking among recently diagnosed HIV+ people who inject drugs in Vietnam. Addict Behav 2019; 95:118-124. [PMID: 30903968 DOI: 10.1016/j.addbeh.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND In Vietnam tobacco smoking is prevalent among people living with HIV (PLHIV) and causes excess mortality in this population. Injection drug use is a driver of HIV infections in Vietnam. Changes in HIV disease state may correlate to changes in smoking among PLHIV. This study investigates the relationship between increases in smoking and health-related variables among recently diagnosed HIV+ people who inject drugs (PWID) in Vietnam. METHODS We analyzed longitudinal data from 323 recently diagnosed HIV+ PWID in a randomized controlled trial from 2009 to 2013 in Thai Nguyen province, Vietnam. The outcome was an increase of >one cigarette/day from baseline visit cigarette smoking. A generalized estimating equation for repeated measures was used to estimate bivariable and multivariable associations between participant characteristics and smoking increases. We collected qualitative data to enhance our understanding of quantitative results, from 16 HIV+ PWID who smoke. RESULTS Ninety three point 5% of participants reported some smoking at baseline. Smoking fewer cigarettes, higher health related quality of life (QOL), and higher CD4 counts were predictive of increases in smoking at future visits in a multivariable model. Qualitative data showed smoking increases were tied to improved perceived health, and counseling during respiratory illnesses may increase intention to quit. CONCLUSION HIV+ PWID in Vietnam smoke at a very high rate. Increases in their smoking are correlated to increases in heath-related QOL, and increases in perceptions of health. Any tobacco-use intervention should account for internal tobacco use triggers faced by HIV+ PWID.
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Effects of post-discharge counseling and medication utilization on short and long-term smoking cessation among hospitalized patients. Prev Med Rep 2019; 15:100937. [PMID: 31338281 PMCID: PMC6630019 DOI: 10.1016/j.pmedr.2019.100937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 11/24/2022] Open
Abstract
Numerous studies have tested the effect of multicomponent post-discharge smoking cessation interventions on post-discharge smoking cessation, and many are effective. However, little is known regarding the relative efficacy of the different intervention components on short or long-term cessation. The present study is a secondary analysis (n = 984) of a randomized controlled trial for hospitalized smokers that took place at two large hospitals in Kansas from 2011 to 2014. All study participants were offered post-discharge quitline services. Pharmacotherapy was recommended during bedside tobacco treatment. The study outcomes were self-reported cessation at 1-month and biochemically verified cessation at 6-months post-randomization. During the post-discharge period, 69% of participants completed at least one quitline call and 28% of participants reported using cessation pharmacotherapy. After controlling for known predictors of cessation among hospitalized smokers, both the number of total quitline calls completed post-discharge and use of cessation pharmacotherapy post-discharge were predictive of cessation at 1-month. After accounting for predictors of cessation and quitting at 1-month, total post-discharge quitline calls was associated with cessation at 6-months (OR [95% CI] = 1.23 [1.12, 1.35], p < 0.001) while post-discharge cessation pharmacotherapy use was not. The results suggest that both engagement in quitline services and use pharmacotherapy independently facilitate cessation beyond the influence of known clinical characteristics associated with cessation. Over the longer term, the effect of engaging in quitline services persists while the effect of pharmacotherapy diminishes. To optimize outcomes, future research should investigate methods to increase utilization of medications and promote sustained counseling engagement in order to sustain the effects of treatment during the post-discharge period. Counseling and pharmacotherapy are effective interventions for helping hospitalized smokers quit smoking, but the relative contribution of each intervention component to short or long-term abstinence is not well understood This secondary analysis of a large clinical trial found that quitline counseling and pharmacotherapy – when used after hospital discharge - were associated with increased odds of quitting smoking at 1-month follow up Controlling for early abstinence at 1 month, only post-discharge quitline counseling remained predictive of cessation at 6-months follow-up Pharmacotherapy and quitline counseling independently facilitate short-term abstinence, while long-term abstinence is facilitated by engagement in quitline counseling services Hospitals could work directly with state quitlines to integrate counseling into post-discharge care
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Li WHC, Ho KY, Xia VW, Wang MP, Lam KKW, Chan SSC, Lam TH. Helping hospitalized smokers in Hong Kong quit smoking by understanding their risk perception, behaviour, and attitudes related to smoking. J Adv Nurs 2019; 75:2167-2177. [DOI: 10.1111/jan.14084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 03/07/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - K. Y. Ho
- School of Nursing The University of Hong Kong Hong Kong China
| | - Viveka W. Xia
- School of Nursing The University of Hong Kong Hong Kong China
| | - M. P. Wang
- School of Nursing The University of Hong Kong Hong Kong China
| | | | | | - T. H. Lam
- School of Public Health The University of Hong Kong Hong Kong China
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Adaptation of a sustained care cessation intervention for smokers hospitalized for psychiatric disorders: Study protocol for a randomized controlled trial. Contemp Clin Trials 2019; 83:18-26. [PMID: 31212100 DOI: 10.1016/j.cct.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with serious mental illness (SMI) smoke at disproportionately higher rates than those without SMI, have lifespans 25-32 years shorter, and thus bear an especially large burden of tobacco-related morbidity and mortality. Several recent studies demonstrate that smokers with SMI can successfully quit smoking with adequate support. Further evidence shows that using technology to deliver sustained care interventions to hospitalized smokers can lead to smoking cessation up to 6 months after discharge. The current comparative effectiveness trial adapts a technology-assisted sustained care intervention designed for smokers admitted to a general hospital and tests whether this approach can produce higher cessation rates compared to usual care for smokers admitted to a psychiatric inpatient unit. METHODS A total of 353 eligible patients hospitalized for psychiatric illness are randomized by cohort into one of two conditions, Sustained Care (SusC) or Usual Care (UC), and are followed for six months after discharge. Participants assigned to UC receive brief tobacco education delivered by a hospital nurse during or soon after admission. Those assigned to SusC receive a 40-min, in-hospital motivational counseling intervention. Upon discharge, they also receive up to 8 weeks of free nicotine patches, automated interactive voice response (IVR) telephone and text messaging, and access to cessation counseling resources lasting 3 months post discharge. Smoking cessation outcomes are measured at 1-, 3- and 6-months post hospital discharge. CONCLUSION Results from this comparative effectiveness trial will add to our understanding of acceptable and effective smoking cessation approaches for patients hospitalized with SMI.
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Abstract
Tobacco cigarette smoking is a serious epidemic that kills several million people each year. Nevertheless, a significant percentage of patients with respiratory diseases continue to smoke after diagnosis, despite the assistance offered, thus reducing the efficacy of the treatments prescribed by the health providers and dramatically increasing the mortality rate. International guidelines have advocated the importance of including smoking cessation protocols in the management of patients' respiratory conditions and pointed out the need to deliver integrated and tailored interventions. Consistently with this framework, the commentary proposes a new clinical approach to smoking cessation in patients with respiratory diseases. This approach integrates, according to P5 personalized medicine, pharmacological and psychological aspects affecting smoking behaviors, overcoming the traditional approach mainly based on the pharmacological interventions.
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Patten CA, Fu S, Vickerman K, Bock MJ, Nelson D, Zhu SH, Balls-Berry JE, Torres AJ, Brockman TA, Hughes CA, Klein AE, Valdez-Soto M, Keller PA. Support person interventions to increase use of quitline services among racially diverse low-income smokers: A pilot study. Addict Behav Rep 2019; 9:100171. [PMID: 31193750 PMCID: PMC6542743 DOI: 10.1016/j.abrep.2019.100171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Social support from nonsmokers may have a role in prompting smokers to use evidence-based cessation treatment. Prior studies found that an intervention for nonsmoking support persons (SPs) was effective for promoting smokers' use of free, state quitline services. This pilot study adapted and assessed feasibility of this intervention for a racially diverse, low-income population. METHODS Single group, non-randomized design enrolling SP-smoker dyads with low income status enrolled in one of three study "waves" of 10 pairs each. Participants were recruited using flyers and in-person outreach methods. The SP intervention included a 1-session coaching call and written materials; study waves 2 and 3 also included text messaging and a monetary incentive for smokers who used quitline services. Using content analysis, the intervention was iteratively adapted based on SP feedback. Baseline measures assessed socio-demographics, dyad and tobacco use characteristics. Follow-up assessments were conducted among SPs at 1-month follow-up and among smokers at 3-months follow-up. Feasibility indicators were recruitment, retention, and SP intervention acceptability and adherence. Secondary outcomes were smokers' use of any quitline service verified by quitline staff and 7-day, point prevalence, biochemically verified smoking abstinence at 3 months. RESULTS Recruitment of 30 dyads was feasible; in-person recruitment methods were the most successful. SPs who completed follow-up assessments found the intervention acceptable, suggesting only minor content modifications, and they perceived the quitline information as novel. But the study had some feasibility challenges (e.g., SP coaching call completion: 60% and SP study retention: 53%). At 3 months, 2 smokers (7%) had used any quitline service and 13% were biochemically confirmed smoking abstinent. CONCLUSIONS This pilot study demonstrated feasibility of recruiting SP-smoker dyads from diverse, low-income communities. While the intervention was well received, its delivery was not feasible in this population. Results suggest that further consumer adaptation of the intervention is needed among both SPs and smokers.
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Affiliation(s)
- Christi A. Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Steven Fu
- Veterans Affairs HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Mail code: 152, Bldg 9, One Veterans Drive, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, United States
| | - Katrina Vickerman
- Optum Center for Wellbeing Research, Optum Health, 999 Third Ave, Seattle, WA 98104, United States
| | - Martha J. Bock
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - David Nelson
- Veterans Affairs HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Mail code: 152, Bldg 9, One Veterans Drive, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, United States
| | - Shu-Hong Zhu
- University of California San Diego, 9500 Gilman Drive #0905, La Jolla, CA 92093, United States
| | - Joyce E. Balls-Berry
- Center for Clinical and Translational Science Community Engagement Program, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Alula Jimenez Torres
- Optum Center for Wellbeing Research, Optum Health, 999 Third Ave, Seattle, WA 98104, United States
| | - Tabetha A. Brockman
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
- Center for Clinical and Translational Science Community Engagement Program, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Christine A. Hughes
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Abigail E. Klein
- Veterans Affairs HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Mail code: 152, Bldg 9, One Veterans Drive, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, United States
| | - Miguel Valdez-Soto
- Center for Clinical and Translational Science Community Engagement Program, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Paula A. Keller
- ClearWay Minnesota℠, 8011 34th Ave S, Suite 400, Minneapolis, MN 55425, United States
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