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Pack QR, Priya A, Lagu TC, Pekow PS, Atreya A, Rigotti NA, Lindenauer PK. Short-Term Safety of Nicotine Replacement in Smokers Hospitalized With Coronary Heart Disease. J Am Heart Assoc 2019; 7:e009424. [PMID: 30371184 PMCID: PMC6222950 DOI: 10.1161/jaha.118.009424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Little is known about the safety of nicotine replacement therapy (NRT) in smokers hospitalized with coronary heart disease. Methods and Results We examined the short‐term safety of NRT use among smokers hospitalized for coronary heart disease in a geographically and structurally diverse sample of US hospitals in the year 2014. We compared smokers who started NRT in the first 2 days of hospitalization with smokers without any exposure to NRT and adjusted for baseline differences through propensity score matching. Outcomes included inpatient mortality, hospital length of stay, and 1‐month readmission. From 270 hospitals, we included 27 459 smokers (mean age, 58 years; 69% men; 56.9% in intensive care unit), of whom 4885 (17.8%) received NRT (97.2% used the nicotine patch, at a median dose of 21 mg/d for 3 days). After propensity matching, covariates were well balanced within each patient group. Among patients with myocardial infarction, compared with patients who did not receive NRT, those who received NRT showed no difference in mortality (2.1% versus 2.3%; P=0.98), mean length of stay (4.4±3.5 versus 4.3±3.3 days; P=0.60), or 1‐month readmission (15.8% versus 14.6%; P=0.31). Results were similar for patients undergoing percutaneous coronary intervention or coronary artery bypass surgery. Conclusions Among smokers hospitalized for treatment of coronary heart disease, use of NRT was not associated with any differences in short‐term outcomes. Given the known beneficial effects of NRT in treating nicotine withdrawal, reducing cravings, and promoting smoking cessation after discharge, our findings suggest that NRT is a safe and reasonable treatment option.
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Affiliation(s)
- Quinn R Pack
- 1 Division of Cardiovascular Medicine Baystate Medical Center Springfield MA.,2 Department of Internal Medicine Baystate Medical Center Springfield MA.,3 Institute for Healthcare Delivery and Population Science Springfield MA.,4 University of Massachusetts Medical School at Baystate Springfield MA
| | - Aruna Priya
- 3 Institute for Healthcare Delivery and Population Science Springfield MA
| | - Tara C Lagu
- 2 Department of Internal Medicine Baystate Medical Center Springfield MA.,3 Institute for Healthcare Delivery and Population Science Springfield MA.,4 University of Massachusetts Medical School at Baystate Springfield MA.,5 Department of Quantitative Health Science University of Massachusetts Medical School Worcester MA
| | - Penelope S Pekow
- 3 Institute for Healthcare Delivery and Population Science Springfield MA.,6 School of Public Health and Health Sciences University of Massachusetts Amherst MA
| | - Auras Atreya
- 1 Division of Cardiovascular Medicine Baystate Medical Center Springfield MA.,2 Department of Internal Medicine Baystate Medical Center Springfield MA
| | - Nancy A Rigotti
- 7 Department of Medicine Tobacco Research and Treatment Center Massachusetts General Hospital and Harvard Medical School Boston MA
| | - Peter K Lindenauer
- 2 Department of Internal Medicine Baystate Medical Center Springfield MA.,3 Institute for Healthcare Delivery and Population Science Springfield MA.,4 University of Massachusetts Medical School at Baystate Springfield MA.,5 Department of Quantitative Health Science University of Massachusetts Medical School Worcester MA
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2
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Sales MPU, Araújo AJD, Chatkin JM, Godoy ID, Pereira LFF, Castellano MVCDO, Tanni SE, Almeida AÁD, Chatkin G, Silva LCCD, Gonçalves CMC, Botelho C, Santos UP, Viegas CADA, Sestelo MR, Meireles RHS, Correa PCRP, Oliveira MEMD, Reichert J, Lima MS, Silva CARD. Update on the approach to smoking in patients with respiratory diseases. J Bras Pneumol 2019; 45:e20180314. [PMID: 31271604 PMCID: PMC6715029 DOI: 10.1590/1806-3713/e20180314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 02/26/2023] Open
Abstract
Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.
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Affiliation(s)
| | - Alberto José de Araújo
- . Núcleo de Estudos e Tratamento do Tabagismo, Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - José Miguel Chatkin
- . Escola de Medicina. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Irma de Godoy
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | | | | - Suzana Erico Tanni
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | | - Gustavo Chatkin
- . Escola de Medicina. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Luiz Carlos Côrrea da Silva
- . Pavilhão Pereira Filho da Santa Casa, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Clóvis Botelho
- . Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá (MT) Brasil
- . Centro Universitário de Várzea Grande - UNIVAG - Várzea Grande (MT) Brasil
| | - Ubiratan Paula Santos
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - Ricardo Henrique Sampaio Meireles
- . Faculdade de Medicina, Universidade Estácio de Sá, Rio de Janeiro, (RJ), Brasil
- . Instituto Estadual de Doenças do Tórax Ary Parreiras - IETAP - Secretaria Estadual de Saúde do Rio de Janeiro, Niterói (RJ) Brasil
| | | | | | - Jonatas Reichert
- . Secretaria de Saúde do Paraná - SESA-PR - Curitiba (PR) Brasil
| | - Mariana Silva Lima
- . Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP) Brasil
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Liebmann EP, Scheuermann TS, Faseru B, Richter KP. Critical steps in the path to using cessation pharmacotherapy following hospital-initiated tobacco treatment. BMC Health Serv Res 2019; 19:246. [PMID: 31018852 PMCID: PMC6480776 DOI: 10.1186/s12913-019-4059-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 04/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background Hospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates. Use of smoking cessation medications following discharge may further increase quit rates. This study aims to identify individual, smoking-related and hospitalization-related predictors of engagement in three different steps in the smoking cessation pharmacotherapy utilization process: 1) receiving medications as inpatient, 2) being discharged with a prescription and 3) using medications at 1-month post-hospitalization, while accounting for associations between these steps. Methods Study data come from a clinical trial (N = 1054) of hospitalized smokers interested in quitting who were randomized to recieve referral to a quitline via either warm handoff or fax. Variables were from the electronic health record, the state tobacco quitline, and participant self-report. Relationships among the predictors and the steps in cessation medication utilization were assessed using bivariate analyses and multivariable path analysis. Results Twenty-eight percent of patients reported using medication at 1-month post-discharge. Receipt of smoking cessation medications while hospitalized (OR = 2.09, 95%CI [1.39, 3.15], p < .001) and discharge with a script (OR = 4.88, 95%CI [3.34, 7.13], p < .001) were independently associated with medication use at 1-month post-hospitalization. The path analysis also revealed that the likelihood of being discharged with a script was strongly influenced by receipt of medication as an inpatient (OR = 6.61, 95%CI [4.66, 9.38], p < .001). A number of other treatment- and individual-level factors were associated with medication use in the hospital, receipt of a script, and use post-discharge. Conclusions To encourage post-discharge smoking cessation medication use, concerted effort should be made to engage smokers in tobacco treatment while in hospital. The individual and hospital-level factors associated with each step in the medication utilization process provide good potential targets for future implementation research to optimize treatment delivery and outcomes. Trial registration Number: NCT01305928. Date registered: February 24, 2011.
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Affiliation(s)
| | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Mailstop 1008, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Babalola Faseru
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Mailstop 1008, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Mailstop 1008, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
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4
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Srivastava AB, Ramsey AT, McIntosh LD, Bailey TC, Fisher SL, Fox L, Castro M, Ma Y, Baker TB, Chen LS, Bierut LJ. Tobacco Use Prevalence and Smoking Cessation Pharmacotherapy Prescription Patterns Among Hospitalized Patients by Medical Specialty. Nicotine Tob Res 2019; 21:631-637. [PMID: 29481616 PMCID: PMC6468129 DOI: 10.1093/ntr/nty031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 02/21/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Effective smoking cessation medications are readily available but may be underutilized in hospital settings. In our large, tertiary care hospital, we aimed to (1) characterize patient tobacco use prevalence across medical specialties, (2) determine smoking cessation pharmacotherapy prescription variation across specialties, and (3) identify opportunities for improvement in practice. METHODS Using electronic health records at Barnes Jewish Hospital, we gathered demographic data, admitting service, admission route, length of stay, self-reported tobacco use, and smoking cessation prescriptions over a 6-year period, from 2010 to 2016. We then compared tobacco use prevalence and smoking cessation prescriptions across medical specialties using a cross-sectional, retrospective design. RESULTS Past 12-month tobacco use was reported by patients in 27.9% of inpatient admissions; prescriptions for smoking cessation pharmacotherapy were provided during 21.5% of these hospitalizations. The proportion of patients reporting tobacco use was highest in psychiatry (55.3%) and lowest in orthopedic surgery (17.1%). Psychiatric patients who reported tobacco use were most likely to receive pharmacotherapy (71.8% of admissions), and plastic surgery patients were least likely (4.7% of admissions). Compared with Caucasian tobacco users, African American patients who used tobacco products were less likely to receive smoking cessation medications (adjusted odds ratio [aOR] = 0.65; 95% confidence interval [CI] = 0.62 to 0.68). CONCLUSIONS Among hospitalized tobacco users, safe and cost-effective pharmacotherapies are under-prescribed. We identified substantial variation in prescribing practices across different medical specialties and demographic groups, suggesting the need for an electronic medical record protocol that facilitates consistent tobacco use cessation pharmacotherapy treatment. IMPLICATIONS Tobacco use cessation pharmacotherapy is underutilized during hospitalization, and prescription rates vary greatly across medical specialties and patient characteristics. Hospitals may benefit from implementing policies and practices that standardize and automate the offer of smoking pharmacotherapy for all hospitalized patients who use tobacco.
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Affiliation(s)
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - Leslie D McIntosh
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO
| | - Thomas C Bailey
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Sherri L Fisher
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - Louis Fox
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Yinjiao Ma
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO
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Barua RS, Rigotti NA, Benowitz NL, Cummings KM, Jazayeri MA, Morris PB, Ratchford EV, Sarna L, Stecker EC, Wiggins BS. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2018; 72:3332-3365. [PMID: 30527452 DOI: 10.1016/j.jacc.2018.10.027] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Pack QR, Priya A, Lagu TC, Pekow PS, Rigotti NA, Lindenauer PK. Smoking Cessation Pharmacotherapy Among Smokers Hospitalized for Coronary Heart Disease. JAMA Intern Med 2017; 177:1525-1527. [PMID: 28828485 PMCID: PMC5820688 DOI: 10.1001/jamainternmed.2017.3489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses data from the Premier Alliance database to assess factors associated with the use of smoking cessation pharmacotherapy in smokers hospitalized for coronary heart disease.
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Affiliation(s)
- Quinn R Pack
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts.,Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Aruna Priya
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
| | - Tara C Lagu
- Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Penelope S Pekow
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Biostatistics, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Peter K Lindenauer
- Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.,Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
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7
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ÜNAL M, Ünal M. SMOKING CESSATION COUNSELLING IN THE HOSPITALS: PROBLEMS AND SOLUTIONS. KONURALP TIP DERGISI 2017. [DOI: 10.18521/ktd.315188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Tague C, Richter KP, Cox LS, Keighley J, Hutcheson T, Fitzgerald SA, Ellerbeck EF. Impact of Telephone-Based Care Coordination on Use of Cessation Medications Posthospital Discharge: A Randomized Controlled Trial. Nicotine Tob Res 2017; 19:299-306. [PMID: 27194545 PMCID: PMC7207068 DOI: 10.1093/ntr/ntw138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 05/07/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smokers benefit from ongoing cessation support upon leaving the hospital and returning to their home environment. This study examined the impact of telephone-delivered care coordination on utilization of and adherence to cessation pharmacotherapy after hospital discharge. METHODS Inpatient smokers (n = 606) were randomized to receive counseling with care coordination (CCC) or counseling alone (C) for smoking cessation. Both groups received written materials and telephone-based cessation counseling during hospitalization and postdischarge. CCC recipients received help in selecting, obtaining, and refilling affordable pharmacotherapy prescriptions during and after hospitalization. Study outcomes included self-reported utilization, duration of use, and type of medication during the 3 months postdischarge. RESULTS Of the 487 (80%) of participants completing 3-month follow-up, 211 (43.3%) reported using cessation pharmacotherapy postdischarge; this did not differ by study arm (CCC: 44.7%, C: 42.0%, p = .55). Use of pharmacotherapy postdischarge was associated with smoking at least 20 cigarettes/day at baseline (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.00-2.19) and receipt of pharmacotherapy during hospitalization (OR: 4.00; 95% CI: 2.39-6.89). Smokers with Medicaid (OR: 2.29; 95% CI: 1.32-4.02) or other insurance (OR: 1.69; 95% CI: 1.01-2.86) were more likely to use pharmacotherapy postdischarge than those with no health care coverage. Less than one in four (23.8% of CCC; 22.2% of C) continued pharmacotherapy beyond 4 weeks. CONCLUSIONS Supplemental care coordination did not improve use of postdischarge pharmacotherapy beyond that of inpatient treatment and behavioral counseling. Insurance coverage and use of medications during the hospitalization are associated with higher use of evidence-based treatment postdischarge. IMPLICATIONS Many hospitalized smokers do not receive the benefits of cessation pharmacotherapy postdischarge and telephone quitline programs often fail to help smokers procure pharmacotherapy. Thus, effective strategies are needed to improve utilization and adherence to evidence-based cessation therapies when smokers leave the hospital. We found that use of postdischarge pharmacotherapy was strongly associated with receipt of pharmacotherapy during the hospitalization and with the availability of insurance to cover the costs of treatment. Additional efforts to coordinate pharmacotherapy services did not improve either utilization or adherence to therapy.
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Affiliation(s)
- Caleb Tague
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Lisa S Cox
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - John Keighley
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Tresza Hutcheson
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Sharon A Fitzgerald
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
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9
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Melzer AC, Feemster LC, Collins MP, Au DH. Predictors of Pharmacotherapy for Tobacco Use Among Veterans Admitted for COPD: The Role of Disparities and Tobacco Control Processes. J Gen Intern Med 2016; 31:623-9. [PMID: 26902236 PMCID: PMC4870422 DOI: 10.1007/s11606-016-3623-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/11/2015] [Accepted: 02/04/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many smokers admitted for chronic obstructive pulmonary disease (COPD) are not given smoking cessation medications at discharge. The reasons behind this are unclear, and may reflect an interplay of patient characteristics, health disparities, and the receipt of inpatient tobacco control processes. OBJECTIVES We aimed to assess potential disparities in treatment for tobacco use following discharge for COPD, examined in the context of inpatient tobacco control processes. PARTICIPANTS Smokers aged ≥ 40 years, admitted for treatment of a COPD exacerbation within the VA Veterans Integrated Service Network 20, identified using ICD-9 discharge codes and admission diagnoses from 2005-2012. MAIN MEASURES The outcome was any tobacco cessation medication dispensed within 48 hours of discharge. We assessed potential predictors administratively up to 1 year prior to admission. We created the final logistic regression model using manual model building, clustered by site. Variables with p < 0.2 in biviariate models were considered for inclusion in the final model. RESULTS We identified 1511 subjects. 16.9 % were dispensed a medication at discharge. In the adjusted model, several predictors were associated with decreased odds of receiving medications: older age (OR per year older 0.96, 95 % CI 0.95-0.98), black race (OR 0.34, 95 % CI 0.12-0.97), higher comorbidity score (OR 0.89, 95 % CI 0.82-0.96), history of psychosis (OR 0.40, 95 % CI 0.31-0.52), hypertension (OR 0.75, 95 % CI 0.62-0.90), and treatment with steroids in the past year (OR 0.80, 95 % CI 0.70-0.90). Inpatient tobacco control processes were associated with increased odds of receiving medications: documented brief counseling at discharge (OR 3.08, 95 % CI 2.02-4.68) and receipt of smoking cessation medications while inpatient (OR 5.95, 95 % CI 3.19-11.10). CONCLUSIONS Few patients were treated with tobacco cessation medications at discharge. We found evidence for disparities in treatment, but also potentially beneficial effects of inpatient tobacco control measures. Further focus should be on using novel processes of care to improve provision of medications and decrease the observed disparities.
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Affiliation(s)
- Anne C Melzer
- Division of Pulmonary and Critical Care, University of Washington, Seattle, WA, USA.
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA.
| | - Laura C Feemster
- Division of Pulmonary and Critical Care, University of Washington, Seattle, WA, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA
| | - Margaret P Collins
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA
| | - David H Au
- Division of Pulmonary and Critical Care, University of Washington, Seattle, WA, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA
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10
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Slattery C, Freund M, Gillham K, Knight J, Wolfenden L, Bisquera A, Wiggers J. Increasing smoking cessation care across a network of hospitals: an implementation study. Implement Sci 2016; 11:28. [PMID: 26927023 PMCID: PMC4772530 DOI: 10.1186/s13012-016-0390-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 02/23/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite clinical practice guidelines recommending the provision of smoking cessation care to all smokers in hospital, the provision of such care can be sub-optimal. A study was conducted to assess the impact of an intervention on the provision of smoking cessation care to nicotine-dependent smokers across a network of hospitals. METHODS A 4-year interrupted time series study was undertaken in a single health district in New South Wales, Australia. A multi-component intervention was implemented over a 2-year period in all 37 public general hospitals. Outcome data were collected from eight randomly selected hospitals via medical record audit. Logistic regression analyses assessed differences between baseline, intervention and follow-up periods in the provision of seven measures of care: brief advice, offer and provision of inpatient and discharge nicotine replacement therapy, and offer and acceptance of referral to a Quitline. RESULTS Approximately 164,250 patients were discharged from the hospitals during the study, 16 % of whom were smokers. Of the selected smokers, 56.12 % (n = 2072) were nicotine-dependent. The prevalence of smoking cessation care increased significantly for all seven measures between baseline and intervention periods, and for six of the seven measures between the baseline and follow-up periods. The odds of receiving care at follow-up were between 1.7 (CI 1.18-2.58, p = 0.0004) and 6.2 (CI 2.84-13.85, p < 0.0001) times greater than at baseline. At follow-up, 53, 16 and 7 of smokers were offered inpatient NRT, discharge NRT and a Quitline referral, respectively. CONCLUSIONS Significant gains in the provision of smoking cessation care were indicated. However, at best, slightly more than half of the patients received smoking cessation care. Additional care enhancement strategies are required if all smokers are to obtain the intended benefits of smoking cessation care guidelines.
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Affiliation(s)
- Carolyn Slattery
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Jenny Knight
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Alessandra Bisquera
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
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11
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Barnoya J, Jin L, Hudmon KS, Schootman M. Nicotine replacement therapy, tobacco products, and electronic cigarettes in pharmacies in St. Louis, Missouri. J Am Pharm Assoc (2003) 2015; 55:405-12. [DOI: 10.1331/japha.2015.14230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Maintenance of tobacco cessation programmes in public hospitals in Catalonia, Spain. Addict Behav 2015; 42:136-9. [PMID: 25462661 DOI: 10.1016/j.addbeh.2014.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 10/13/2014] [Accepted: 11/19/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The provision of smoking cessation interventions in hospitals has been strongly recommended. The aim of this study is to determine the maintenance of smoking cessation programmes for inpatients and hospital workers in hospitals of Catalonia (Spain) seven years after the implementation of a Tobacco Cessation Programme. METHODS A cross-sectional survey was conducted in all hospitals that offer public service in Catalonia, Spain (n=73). An online questionnaire was sent to all coordinators of the smoke-free hospital project or managers of each hospital. The survey included questions about the type of hospital, type of programmes implemented and availability and source of smoking cessation drugs. RESULTS Responses to the questionnaire were submitted by 58 hospitals (79.5%). 74% and 93.1% of the hospitals had smoking cessation programmes for inpatients and workers, respectively. Most of the hospitals maintained the programmes and started routinely buying smoking cessation drugs after a period of receiving them free-of-charge. However, 17.2% of the hospitals refused to buy these drugs and 24% never had these drugs available. CONCLUSIONS Through a supportive Tobacco Cessation Programme, most hospitals have smoking cessation programmes for both patients and workers. Most of them have incorporated smoking cessation drugs as a regular resource in their services' portfolio. The lack of these resources may jeopardise the maintenance of well-established programmes in hospitals.
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Reid ZZ, Regan S, Kelley JHK, Streck JM, Ylioja T, Tindle HA, Chang Y, Levy DE, Park ER, Singer DE, Carpenter KM, Reyen M, Rigotti NA. Comparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers: study protocol for the Helping HAND 2 randomized controlled trial. BMC Public Health 2015; 15:109. [PMID: 25879193 PMCID: PMC4328622 DOI: 10.1186/s12889-015-1484-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 11/13/2022] Open
Abstract
Background Smoking cessation interventions for hospitalized smokers are effective in promoting smoking cessation, but only if the tobacco dependence treatment continues after the patient leaves the hospital. Sustaining tobacco dependence treatment after hospital discharge is a challenge for health care systems. Our previous single-site randomized controlled trial demonstrated the effectiveness of an intervention that facilitated the delivery of comprehensive tobacco cessation treatment, including both medication and counseling, after hospital discharge. We subsequently streamlined the intervention model to increase its potential for dissemination. This new model is being tested in a larger multi-site trial with broader eligibility criteria in order to enroll a more representative sample of hospitalized smokers. This paper describes the trial design and contrasts it with the earlier study. Methods/Design A 2-arm, 3-site randomized controlled trial is testing the hypothesis that a multi-component Sustained Care intervention is more effective than Standard Care in helping hospitalized cigarette smokers stop smoking after hospital discharge. The trial enrolls adult daily cigarette smokers who are admitted to 1 of 3 participating hospitals in Massachusetts or Pennsylvania. Participants receive the same smoking cessation intervention in the hospital. They are randomly assigned to receive either Standard Care or Sustained Care after hospital discharge. Participants in the Sustained Care arm receive a free 3-month supply of FDA-approved smoking cessation medication and 5 interactive voice response calls that provide tailored motivational messages, medication refills, and access to a live tobacco treatment counselor. Participants in the Standard Care arm receive a smoking cessation medication recommendation and information about community resources. Outcomes are assessed at 1, 3, and 6 months after discharge. The primary outcome is biochemically-validated tobacco abstinence for the past 7 days at 6-month follow-up. Other outcome measures include self-reported tobacco abstinence measures, use of medication and counseling after discharge, hospital readmissions, and program cost-effectiveness. Discussion We adapted a proven intervention for hospitalized smokers to enhance its potential for dissemination and are testing it in a multi-site trial. Study enrollment data suggests that the trial achieved the goal of recruiting a broader sample of hospitalized smokers. Trial registration Comparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers (Helping HAND2) NCT01714323. Registered October 22, 2012.
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Affiliation(s)
- Zachary Z Reid
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA. .,Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA, USA.
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA. .,Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Jennifer H K Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA. .,Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA, USA.
| | - Joanna M Streck
- Department of Psychology, University of Vermont, Burlington, VT, USA.
| | - Thomas Ylioja
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt Initiatives in Tobacco, Addiction and Lifestyle (VITAL) Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Yuchiao Chang
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Douglas E Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA. .,Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Elyse R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA. .,Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Daniel E Singer
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Michele Reyen
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA. .,Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA, USA.
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA. .,Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA, USA. .,Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Rigotti NA, Regan S, Levy DE, Japuntich S, Chang Y, Park ER, Viana JC, Kelley JHK, Reyen M, Singer DE. Sustained care intervention and postdischarge smoking cessation among hospitalized adults: a randomized clinical trial. JAMA 2014; 312:719-28. [PMID: 25138333 PMCID: PMC4507269 DOI: 10.1001/jama.2014.9237] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Health care systems need effective models to manage chronic diseases like tobacco dependence across transitions in care. Hospitalizations provide opportunities for smokers to quit, but research suggests that hospital-delivered interventions are effective only if treatment continues after discharge. OBJECTIVE To determine whether an intervention to sustain tobacco treatment after hospital discharge increases smoking cessation rates compared with standard care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial compared sustained care (a postdischarge tobacco cessation intervention) with standard care among 397 hospitalized daily smokers (mean age, 53 years; 48% were males; 81% were non-Hispanic whites) who wanted to quit smoking after discharge and received a tobacco dependence intervention in the hospital; 92% of eligible patients and 44% of screened patients enrolled. The study was conducted from August 2010 through November 2012 at Massachusetts General Hospital. INTERVENTIONS Sustained care participants received automated interactive voice response telephone calls and their choice of free smoking cessation medication (any type approved by the US Food and Drug Administration) for up to 90 days. The automated telephone calls promoted cessation, provided medication management, and triaged smokers for additional counseling. Standard care participants received recommendations for postdischarge pharmacotherapy and counseling. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically confirmed past 7-day tobacco abstinence at 6-month follow-up after discharge from the hospital; secondary outcomes included self-reported tobacco abstinence. RESULTS Smokers randomly assigned to sustained care (n = 198) used more counseling and more pharmacotherapy at each follow-up assessment than those assigned to standard care (n = 199). Biochemically validated 7-day tobacco abstinence at 6 months was higher with sustained care (26%) than with standard care (15%) (relative risk [RR], 1.71 [95% CI, 1.14-2.56], P = .009; number needed to treat, 9.4 [95% CI, 5.4-35.5]). Using multiple imputation for missing outcomes, the RR for 7-day tobacco abstinence was 1.55 (95% CI, 1.03-2.21; P = .04). Sustained care also resulted in higher self-reported continuous abstinence rates for 6 months after discharge (27% vs 16% for standard care; RR, 1.70 [95% CI, 1.15-2.51]; P = .007). CONCLUSIONS AND RELEVANCE Among hospitalized adult smokers who wanted to quit smoking, a postdischarge intervention providing automated telephone calls and free medication resulted in higher rates of smoking cessation at 6 months compared with a standard recommendation to use counseling and medication after discharge. These findings, if replicated, suggest an approach to help achieve sustained smoking cessation after a hospital stay. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01177176.
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Affiliation(s)
- Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Sandra Japuntich
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Yuchiao Chang
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Elyse R. Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Joseph C. Viana
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, CA
| | - Jennifer H. K. Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, MA
| | - Michele Reyen
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
| | - Daniel E. Singer
- Division of General Internal Medicine, Medical Service, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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