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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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Lim S, Wyatt LC, Mammen S, Zanowiak JM, Mohaimin S, Troxel AB, Lindau ST, Gold HT, Shelley D, Trinh-Shevrin C, Islam NS. Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative. BMC Endocr Disord 2021; 21:233. [PMID: 34814899 PMCID: PMC8609264 DOI: 10.1186/s12902-021-00885-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging health information technology (HIT) have been developed to mitigate disease among this population. This paper describes the protocol for a multi-level, community-clinical linkage intervention to improve glycemic control among South Asians with uncontrolled diabetes. METHODS The study includes three components: 1) building the capacity of primary care practices (PCPs) to utilize electronic health record (EHR) registries to identify patients with uncontrolled diabetes; 2) delivery of a culturally- and linguistically-adapted CHW intervention to improve diabetes self-management; and 3) HIT-enabled linkage to culturally-relevant community resources. The CHW intervention component includes a randomized controlled trial consisting of group education sessions on diabetes management, physical activity, and diet/nutrition. South Asian individuals with type 2 diabetes are recruited from 20 PCPs throughout NYC and randomized at the individual level within each PCP site. A total of 886 individuals will be randomized into treatment or control groups; EHR data collection occurs at screening, 6-, 12-, and 18-month. We hypothesize that individuals receiving the multi-level diabetes management intervention will be 15% more likely than the control group to achieve ≥0.5% point reduction in hemoglobin A1c (HbA1c) at 6-months. Secondary outcomes include change in weight, body mass index, and LDL cholesterol; the increased use of community and social services; and increased health self-efficacy. Additionally, a cost-effectiveness analysis will focus on implementation and healthcare utilization costs to determine the incremental cost per person achieving an HbA1c change of ≥0.5%. DISCUSSION Final outcomes will provide evidence regarding the effectiveness of a multi-level, integrated EHR-CHW intervention, implemented in small PCP settings to promote diabetes control among an underserved South Asian population. The study leverages multisectoral partnerships, including the local health department, a healthcare payer, and EHR vendors. Study findings will have important implications for the translation of integrated evidence-based strategies to other minority communities and in under-resourced primary care settings. TRIAL REGISTRATION This study was registered with clinicaltrials.gov: NCT03333044 on November 6, 2017.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
| | - Laura C Wyatt
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Shinu Mammen
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Jennifer M Zanowiak
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Sadia Mohaimin
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Andrea B Troxel
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, 5841 Maryland Avenue MC 2050, Chicago, IL, 60637, USA
| | - Heather T Gold
- Department of Population Health, NYU Grossman School of Medicine, 550 First Ave, VZ30, 6th floor, New York, NY, 10016, USA
| | - Donna Shelley
- Department of Public Health Policy and Management Department, NYU Global School of Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia S Islam
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
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Santos MDDV, Santos SV, Caccia-Bava MDCGG. [The prevalence of strategies for cessation of tobacco use in primary health care: an integrative review]. CIENCIA & SAUDE COLETIVA 2019; 24:563-572. [PMID: 30726388 DOI: 10.1590/1413-81232018242.27712016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/23/2017] [Indexed: 11/22/2022] Open
Abstract
The habit of tobacco use/smoking, which is a major concern of Primary Health Care (PHC), is a serious public health problem and the main avoidable cause of death in the world. The relevance of actions, whose focus is to facilitate the cessation of this habit, motivates the discussion of studies that have different approaches to tackle this issue by seeking to train PHC professionals accordingly. A search was conducted in the Lilacs, MEDLINE and Web of Science databases for recent scientific publications (2010-2015). The key words were combined with Boolean operators and, after analysis of the articles found, 75 are discussed in this article since they have strategies with a higher prevalence in PHC. The conclusion drawn is that the brief or intense individual approach using the 5A method (Transtheoretical Model) is the most widely adopted, as well as bupropion and nicotine replacement patches. The increasing use of hard technology requires new studies that examine their impact on the treatment of smokers. It was clearly revealed that there is a need for health professionals to be better prepared to address the issue with the users, in addition to a lack of stimulus and proper conditions to work in the PHC team directly reflecting scientific advances in clinical practice.
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Affiliation(s)
- Meire de Deus Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
| | - Stella Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2018. SELECTION CRITERIA Randomised or quasi-randomised controlled trials which offered proactive or reactive telephone counselling to smokers to assist smoking cessation. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We pooled studies using a random-effects model and assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I2 statistic. In trials including smokers who did not call a quitline, we used meta-regression to investigate moderation of the effect of telephone counselling by the planned number of calls in the intervention, trial selection of participants that were motivated to quit, and the baseline support provided together with telephone counselling (either self-help only, brief face-to-face intervention, pharmacotherapy, or financial incentives). MAIN RESULTS We identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long-term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms.Among trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self-help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate.In studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate. In subgroup analysis, we found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta-regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self-help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate-certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. There is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. Evidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention.
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Affiliation(s)
| | - José M. Ordóñez‐Mena
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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Lopez PM, Zanowiak J, Goldfeld K, Wyka K, Masoud A, Beane S, Kumar R, Laughlin P, Trinh-Shevrin C, Thorpe L, Islam N. Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients. BMC Health Serv Res 2017; 17:810. [PMID: 29207983 PMCID: PMC5717844 DOI: 10.1186/s12913-017-2767-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/24/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge. METHODS Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled. DISCUSSION Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices. TRIAL REGISTRATION This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.
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Affiliation(s)
- Priscilla M. Lopez
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Jennifer Zanowiak
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Keith Goldfeld
- Department of Population Health, NYU School of Medicine, New York, USA
| | - Katarzyna Wyka
- CUNY Graduate School of Public Health and Health Policy, New York, USA
| | | | | | | | | | - Chau Trinh-Shevrin
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Lorna Thorpe
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Nadia Islam
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
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Trout S, Ripley-Moffitt C, Meernik C, Greyber J, Goldstein AO. Provider satisfaction with an inpatient tobacco treatment program: results from an inpatient provider survey. Int J Gen Med 2017; 10:363-369. [PMID: 29089783 PMCID: PMC5655129 DOI: 10.2147/ijgm.s136965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Hospitalization offers an optimal environment for ensuring that patients receive evidence-based treatment. An inpatient tobacco treatment program can deliver interventions broadly, but minimal research has examined the impacts of a consult program on inpatient providers. The Nicotine Dependence Program at the University of North Carolina has provided an inpatient tobacco treatment consult service since 2010. OBJECTIVE The program sought feedback from inpatient providers to examine factors that prompted tobacco treatment consult orders, the impact on provider counseling behavior, provider satisfaction, and suggested program improvements. DESIGN Providers who had ordered a tobacco treatment consult received an online anonymous survey. SETTING The University of North Carolina Hospital is an academic medical facility with 803 beds and over 37,000 inpatient admissions annually from all 100 counties in North Carolina. Approximately 20% of these inpatients report current use of any tobacco product. PATIENTS/PARTICIPANTS Medical providers who ordered inpatient tobacco treatment consults from July 2012 to June 2013 (n=265) received the survey, with 118 providers responding (44.5% response rate). RESULTS Almost all providers reported being satisfied with the consult program and believed it was effective. Key factors in provider satisfaction included ease of accessing the service, saving provider time, and offering patients evidence-based tobacco use treatment. The consult program increased the likelihood of providers prescribing tobacco cessation medications at discharge, as well as following up at post-discharge appointments. CONCLUSION This is some of the first research to show provider satisfaction, program usage, and outcomes with an inpatient tobacco treatment program and demonstrates the important impact of implementing tobacco treatment services within hospitals.
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Affiliation(s)
- Susan Trout
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Carol Ripley-Moffitt
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Clare Meernik
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jennifer Greyber
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Adam O Goldstein
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Abstract
BACKGROUND System change interventions for smoking cessation are policies and practices designed by organizations to integrate the identification of smokers and the subsequent offering of evidence-based nicotine dependence treatments into usual care. Such strategies have the potential to improve the provision of smoking cessation support in healthcare settings, and cessation outcomes among those who use them. OBJECTIVES To assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both. SEARCH METHODS We searched databases including the Cochrane Tobacco Addiction Group Specialized Register, CENTRAL, MEDLINE, Embase, CINAHL, and PsycINFO in February 2016. We also searched clinical trial registries: WHO clinical trial registry, US National Institute of Health (NIH) clinical trial registry. We checked 'grey' literature, and handsearched bibliographies of relevant papers and publications. SELECTION CRITERIA Randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs and interrupted time series studies that evaluated a system change intervention, which included identification of all smokers and subsequent offering of evidence-based nicotine dependence treatment. DATA COLLECTION AND ANALYSIS Using a standardized form, we extracted data from eligible studies on study settings, participants, interventions and outcomes of interest (both cessation and system-level outcomes). For cessation outcomes, we used the strictest available criteria to define abstinence. System-level outcomes included assessment and documentation of smoking status, provision of advice to quit or cessation counselling, referral and enrolment in quitline services, and prescribing of cessation medications. We assessed risks of bias according to the Cochrane Handbook and categorized each study as being at high, low or unclear risk of bias. We used a narrative synthesis to describe the effectiveness of the interventions on various outcomes, because of significant heterogeneity among studies. MAIN RESULTS We included seven cluster-randomized controlled studies in this review. We rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow-up (four studies), and for the secondary outcome 'prescribing of smoking cessation medications' (two studies). Four studies evaluated changes in provision of smoking cessation counselling and three favoured the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrolment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. AUTHORS' CONCLUSIONS The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counselling and referral to smoking cessation services. However, as the available research is limited we are not able to draw strong conclusions. There is a need for additional high-quality research to explore the impact of system change interventions on both cessation and system-level outcomes.
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Affiliation(s)
- Dennis Thomas
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash UniversityCentre for Medicine Use and SafetyParkville Campus381 Royal ParadeParkvilleVictoriaAustralia3052
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash UniversityEpidemiology & Preventive MedicineMelbourneVictoriaAustralia3004
| | - Billie Bonevski
- University of NewcastleSchool of Medicine & Public HealthDavid Maddison BuildingCnr of King and Watt StreetsNewcastleNSWAustralia2300
| | - Johnson George
- Monash UniversityCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesParkvilleVICAustralia3052
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Duffy SA, Ronis DL, Ewing LA, Waltje AH, Hall SV, Thomas PL, Olree CM, Maguire KA, Friedman L, Klotz S, Jordan N, Landstrom GL. Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals. Implement Sci 2016; 11:147. [PMID: 27814722 PMCID: PMC5097410 DOI: 10.1186/s13012-016-0511-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 10/17/2016] [Indexed: 01/24/2023] Open
Abstract
Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended). Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive (“user friendly,” “streamlined,” or “saves time”), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended. Conclusions Given that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation. Trial registration ClinicalTrials.gov, NCT01309217 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0511-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sonia A Duffy
- College of Nursing, Ohio State University, Newton Hall, 1585 Neil Ave, Columbus, OH, 43210, USA. .,Veterans Affairs (VA) Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
| | - David L Ronis
- University of Michigan School of Nursing, 400 North Ingalls Building Room 4330, Ann Arbor, MI, 48109-0482, USA
| | - Lee A Ewing
- VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Andrea H Waltje
- Internal Medicine, Brehm Tower, University of Michigan, Room 6115, 1000 Wall Street, Ann Arbor, MI, 48109-5714, USA
| | - Stephanie V Hall
- VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | | | - Christine M Olree
- The Lacks Cancer Center, Mercy Health Saint Mary's, 200 Jefferson SE, Grand Rapids, MI, 49503, USA
| | | | - Lisa Friedman
- Saint Joseph Mercy Health System, 5305 E. Huron River Dr., Ann Arbor, MI, 48106-0995, USA
| | - Sue Klotz
- Saint Mary Mercy Hospital, 36475 Five Mile Road, Livonia, MI, 48154-1988, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Abbott Hall 710 North Lake Shore Drive, Suite 904, Chicago, IL, 60611, USA.,Center for Management of Complex Chronic Care, Hines VA Hospital, 5000 S 5th Ave., Hines, IL, 60141, USA
| | - Gay L Landstrom
- Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH, 03756, USA
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Cruvinel E, Richter KP, Stoney C, Duffy S, Fellows J, Harrington KF, Rigotti NA, Sherman S, Tindle HA, Shireman TI, Shelley D, Waiwaiole L, Cummins S. CHARTing a Path to Pragmatic Tobacco Treatment Research. Am J Prev Med 2016; 51:630-6. [PMID: 27647063 PMCID: PMC5919279 DOI: 10.1016/j.amepre.2016.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It is important to consider the degree to which studies are explanatory versus pragmatic to understand the implications of their findings for patients, healthcare professionals, and policymakers. Pragmatic trials test the effectiveness of interventions in real-world conditions; explanatory trials test for efficacy under ideal conditions. The Consortium of Hospitals Advancing Research on Tobacco (CHART) is a network of seven NIH-funded trials designed to identify effective programs that can be widely implemented in routine clinical practice. METHODS A cross-sectional analysis of CHART trial study designs was conducted to place each study on the pragmatic-explanatory continuum. After reliability training, six raters independently scored each CHART study according to ten PRagmatic Explanatory Continuum Indicator Summary (PRECIS) dimensions, which covered participant eligibility criteria, intervention flexibility, practitioner expertise, follow-up procedures, participant compliance, practitioner adherence, and outcome analyses. Means and SDs were calculated for each dimension of each study, with lower scores representing more pragmatic elements. Results were plotted on "spoke and wheel" diagrams. The rating process and analyses were performed in October 2014 to September 2015. RESULTS All seven CHART trials tended toward the pragmatic end of the spectrum, although there was a range from 0.76 (SD=0.23) to 1.85 (SD=0.58). Most studies included some explanatory design elements. CONCLUSIONS CHART findings should be relatively applicable to clinical practice. Funders and reviewers could integrate PRECIS criteria into their guidelines to better facilitate pragmatic research. CHART study protocols, coupled with scores reported here, may help readers improve the design of their own pragmatic trials.
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Affiliation(s)
- Erica Cruvinel
- Department of Psychology, Federal University of Juiz de Fora, Minas Gerais, Brazil.
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Catherine Stoney
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Sonia Duffy
- College of Nursing, Ohio State University, Columbus, Ohio; Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jeffrey Fellows
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Kathleen F Harrington
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nancy A Rigotti
- Department of Medicine and Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott Sherman
- Departments of Population Health, Medicine and Psychiatry; New York University School of Medicine, New York, New York
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Theresa I Shireman
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Lisa Waiwaiole
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Sharon Cummins
- Department of Family Medicine and Public Health, University of California, San Diego, California
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10
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Fellows JL, Mularski RA, Leo MC, Bentz CJ, Waiwaiole LA, Francisco MC, Funkhouser K, Stoney CM. Referring Hospitalized Smokers to Outpatient Quit Services: A Randomized Trial. Am J Prev Med 2016; 51:609-19. [PMID: 27647061 PMCID: PMC5031367 DOI: 10.1016/j.amepre.2016.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/27/2016] [Accepted: 06/17/2016] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Linking outpatient cessation services to bedside counseling for hospitalized smokers can improve long-run quit rates. Adding an assisted referral (AR) offer to a tobacco treatment specialist consult service fits the team approach to care in U.S. hospitals. DESIGN A two-arm patient-randomized trial tested the effectiveness of adding an AR offer to outpatient smoking-cessation services and interactive voice recognition (AR+IVR) follow-up to a usual care (UC) tobacco-cessation consult for hospitalized smokers. SETTING/PARTICIPANTS Over 24 months (November 2011-November 2013), 898 hospitalized adult smokers interested in quitting smoking were recruited from three large hospitals in the Portland, Oregon, area: an integrated group model HMO (n=622), a community hospital (n=195), and an academic health center (n=81). INTERVENTION Tobacco treatment specialists identified smokers and provided an intensive bedside tobacco use assessment and cessation consultation (UC). AR+IVR recipients also received proactive ARs to available outpatient counseling programs and medications, and linked patients to a tailored IVR telephone follow-up system. MAIN OUTCOME MEASURES The primary outcome was self-reported 30-day abstinence at 6-month follow-up. Secondary outcomes included self-reported and continuous abstinence and biochemically confirmed 7-day abstinence at 6 months. Follow-up was completed in September 2014; data were analyzed in 2015. RESULTS A total of 597 and 301 hospitalized smokers were randomized to AR+IVR and UC, respectively. AR+IVR and UC recipients received 19.3 and 17.0 minutes of bedside counseling (p=0.372), respectively. Most (58%) AR+IVR patients accepted referrals for counseling, 43% accepted medications, and 28% accepted both. Self-reported 30-day abstinence for AR+IVR (17.9%) and UC (17.3%) were not statistically significant (p=0.569). Differences in 7-day, continuous, and biochemically confirmed abstinence by treatment group also were insignificant, overall and adjusting for site. CONCLUSIONS Adding an AR to outpatient counseling and medications did not increase cigarette abstinence at 6 months compared to UC alone.
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Affiliation(s)
| | | | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Charles J Bentz
- Tobacco Cessation and Prevention, Legacy Health System, Portland, Oregon
| | | | | | | | - Catherine M Stoney
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
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11
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Schulte DM, Duster M, Warrack S, Valentine S, Jorenby D, Shirley D, Sosman J, Catz S, Safdar N. Feasibility and patient satisfaction with smoking cessation interventions for prevention of healthcare-associated infections in inpatients. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:15. [PMID: 27113448 PMCID: PMC4845502 DOI: 10.1186/s13011-016-0059-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/17/2016] [Indexed: 01/25/2023]
Abstract
Background Smoking increases hospitalization and healthcare-associated infection. Our primary aim of this pilot, randomized-controlled trial was to examine the feasibility and acceptability of a tobacco cessation intervention compared with usual care in inpatients. S. aureus carriage, healthcare-associated infections and infections post discharge were exploratory outcomes. Methods Current inpatient smokers from a university hospital facility were randomized to usual care or a face to face tobacco cessation counseling session where patients’ tobacco use and strategies for quitting were discussed. Patient engagement, satisfaction and withdrawal symptoms were measured at 1 week and 12 weeks post discharge. Nasal swabs were collected at enrollment and discharge and assessed for S. aureus colonization. P-values were calculated using Fisher’s exact and t-tests were used to compare groups. Results For the study’s primary outcome, participants reported the intervention as being generally acceptable and reported high overall levels of satisfaction, with a Likert scale score of at least 4/5 for all measures of satisfaction. No subjects utilized free tobacco cessation services after discharge. 83 % of the intervention group and 93 % of the control group smoked at least one cigarette after discharge. Secondary outcomes with regard to infections showed that, at discharge, 12 % of the intervention group (n = 17) and 18 % of the control group (n = 22) tested positive for S. aureus. After 3 months, 9 % of the intervention group developed infection, 41 % visited an emergency room, and 24 % were readmitted within 3 months post-discharge, compared to 27, 32 and 36 % of the control group respectively. Conclusions With regards to the primary aim of this study, there were overall high levels of satisfaction with the intervention, indicating good feasibility and acceptance among patients. However, more intensive interventions in hospitalized patients and impact on healthcare-associated infections and post-discharge infections should be explored.
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Affiliation(s)
- Danielle M Schulte
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
| | - Megan Duster
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Simone Warrack
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Susan Valentine
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Douglas Jorenby
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel Shirley
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - James Sosman
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sheryl Catz
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin Hospitals and Clinics, Madison, WI, USA. .,William S. Middleton Memorial Veterans Affairs Medical Center, 5221 MFCB, 1685 Highland Avenue, Madison, WI, 53705, USA.
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12
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Duffy SA, Cummins SE, Fellows JL, Harrington KF, Kirby C, Rogers E, Scheuermann TS, Tindle HA, Waltje AH. Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART). Tob Induc Dis 2015; 13:29. [PMID: 26336372 PMCID: PMC4557818 DOI: 10.1186/s12971-015-0056-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles. METHODS Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented. RESULTS Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures. CONCLUSION While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability. TRIAL REGISTRATION Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217.Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275.Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928.Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250.Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245.Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176.Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079.
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Affiliation(s)
- Sonia A. Duffy
- />Ohio State University, College of Nursing, Newton Hall, 1585 Neil Ave, Columbus, OH 43210 USA
- />VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI 48105 USA
| | - Sharon E. Cummins
- />Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
| | - Jeffrey L. Fellows
- />Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227 USA
| | - Kathleen F. Harrington
- />Division of Pulmonary Medicine, University of Alabama at Birmingham, 1900 University Blvd., THT541-G1, Birmingham, AL 35294-0006 USA
| | - Carrie Kirby
- />Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
| | - Erin Rogers
- />Department of Population Health, New York University School of Medicine, 227 E. 30th St., New York, NY & VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY USA
| | - Taneisha S. Scheuermann
- />Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Hilary A. Tindle
- />Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 370, Nashville, TN 37203 USA
| | - Andrea H. Waltje
- />University of Michigan, Internal Medicine, Brehm Tower, Room 6115, 1000 Wall Street, Ann Arbor, MI 48109-5714 USA
| | - the Consortium of Hospitals Advancing Research on Tobacco (CHART)
- />Ohio State University, College of Nursing, Newton Hall, 1585 Neil Ave, Columbus, OH 43210 USA
- />VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI 48105 USA
- />Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
- />Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227 USA
- />Division of Pulmonary Medicine, University of Alabama at Birmingham, 1900 University Blvd., THT541-G1, Birmingham, AL 35294-0006 USA
- />Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
- />Department of Population Health, New York University School of Medicine, 227 E. 30th St., New York, NY & VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY USA
- />Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
- />Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 370, Nashville, TN 37203 USA
- />University of Michigan, Internal Medicine, Brehm Tower, Room 6115, 1000 Wall Street, Ann Arbor, MI 48109-5714 USA
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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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14
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Islam N, Nadkarni SK, Zahn D, Skillman M, Kwon SC, Trinh-Shevrin C. Integrating community health workers within Patient Protection and Affordable Care Act implementation. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21:42-50. [PMID: 25414955 PMCID: PMC4416641 DOI: 10.1097/phh.0000000000000084] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The Patient Protection and Affordable Care Act's (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. OBJECTIVE This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. RESULTS Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers' role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers' unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. CONCLUSION Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models.
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Affiliation(s)
- Nadia Islam
- Department of Population Health, NYU School of Medicine, New York, New York (Drs Islam, Kwon, and Trinh-Shevrin); NYU Prevention Research Center, New York, New York (Drs Islam, Kwon, and Trinh-Shevrin and Ms Nadkarni); NYU Center for the Study of Asian American Health, New York, New York (Drs Islam, Kwon, and Trinh-Shevrin and Ms Nadkarni); Health Management Associates, New York, New York (Ms Zahn); and NYU Robert F. Wagner School of Public Service, New York, New York (Ms Skillman)
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15
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Rigotti NA, Harrington KF, Richter K, Fellows JL, Sherman SE, Grossman E, Chang Y, Tindle HA, Ylioja T. Increasing prevalence of electronic cigarette use among smokers hospitalized in 5 US cities, 2010-2013. Nicotine Tob Res 2014; 17:236-44. [PMID: 25168031 DOI: 10.1093/ntr/ntu138] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Little is known about the pattern of electronic cigarette (e-cigarette) use over time or among smokers with medical comorbidity. METHODS We assessed current cigarette smokers' use of e-cigarettes during the 30 days before admission to 9 hospitals in 5 geographically dispersed US cities: Birmingham, AL; Boston, MA; Kansas City, KS; New York, NY; and Portland, OR. Each hospital was conducting a randomized controlled trial as part of the NIH-sponsored Consortium of Hospitals Advancing Research on Tobacco (CHART). We conducted a pooled analysis using multiple logistic regression to examine changes in e-cigarette use over time and to identify correlates of e-cigarette use. RESULTS Among 4,660 smokers hospitalized between July 2010 and December 2013 (mean age 57 years, 57% male, 71% white, 56% some college, average 14 cigarettes/day), 14% reported using an e-cigarette during the 30 days before admission. The prevalence of e-cigarette use increased from 1.1% in 2010 to 10.3% in 2011, 10.2% in 2012, and 18.4% in 2013; the increase was statistically significant (p < .0001) after adjustment for age, sex, education, and CHART study. Younger, better educated, and heavier smokers were more likely to use e-cigarettes. Smokers who were Hispanic, non-Hispanic black, and who had Medicaid or no insurance were less likely to use e-cigarettes. E-cigarette use also varied by CHART project and by geographic region. CONCLUSIONS E-cigarette use increased substantially from 2010 to 2013 among a large sample of hospitalized adult cigarette smokers. E-cigarette use was more common among heavier smokers and among those who were younger, white, and who had higher socioeconomic status.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA;
| | - Kathleen F Harrington
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kimber Richter
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS
| | | | - Scott E Sherman
- Division of General Internal Medicine, New York University School of Medicine, New York, NY
| | - Ellie Grossman
- Division of General Internal Medicine, New York University School of Medicine, New York, NY
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Hilary A Tindle
- Division of General Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas Ylioja
- Division of General Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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