The hospital setting is an ideal environment to counsel patients on smoking cessation. The effectiveness of hospital‐based care for smoking is unclear, specifically among African Americans, who face a disproportionate burden of tobacco‐related disease. This study assessed Ihe quality and efficacy of usual care on chemically verified quit rates 4 weeks postdischarge.
Current smoking general medicine inpatients were identified using National Health Interview Survey items. Smokers were interviewed at admission about smoking behaviors and barriers to cessation. At discharge, they were asked to provide an expired carton monoxide (CO) test for verification of abstinence. Smokers were interviewed by phone 4 weeks postdischarge regarding any care they received for their tobacco use (advice to quit, medicalions, or follow‐up wilh a tobacco cessation program). Self‐reported quitters were asked to relurn for CO testing to verify abstinence.
From September 2008 to July 2009, 225 of 289 hospitalized smokers (78%) participated in the study. Of the 225 patients, 193 (86%) were African American, 115 (52%) female, and 77 (34%) had a discharge diagnosis of a smoking‐related illness. The mean age of smokers was 50 ± 14 years, and the mean age they smoked their first cigarette was 16 ± 5 years. One hundred and seventy‐eight (79%) received advice to quit in the last year, and 130 (58%) had tried to quit unsuccessfully in the last year. The mean Fagerstrom score was 4.62 ± 2.13, demonstrating a moderate level of tobacco addiction. The majority of smokers (87%) reported a preference for mentholated cigarettes. Biochemically verified abstinence was demonstrated in 85% of patients at the time of discharge. A 4‐week telephone interview was obtained in 192 of 225 patients (85%). One hundred and eighteen (62%) reported receiving advice to quit from a health care professional in the hospital. Medications for withdrawal (i.e., NRT) were prescribed for 56 patients (29%). Only 8 patients (4%) reported being prescribed a medication (i.e., bupropion) for cessation in the hospital. A referral to the outpatient tobacco cessation program was given to 57 patients (30%) prior to discharge. At 4 weeks, 7 (4%) self‐reported taking medications for smoking cessation, 20 (11%) agreed to being referred to a tobacco cessation program, and only 1 patient enrolled in the program. Additionally, 47 (25%) self‐reported abstinence and 22 (11%) had biochemically confirmed abstinence. Biochemically confirmed abstinence was not higher in patients who were initiated on meds in the hospital (7 v. 13%, P = 0.22).
Usual care in the hospital setting is both suboptimal and largely ineffective. This study demonstrated no significant difference in quit rates among patients initiated on pharmacotherapy in the hospital. Patients may benefit from more intensive postdischarge care in addition to the usual care initiated in the hospital. Further studies are needed to determine cost‐effective and efficient methods to deliver this level of tobacco cessation care in urban hospital settings.
L. Shah, none; V. Press, none; V. Arora, none; A. King, none; D. Meltzer, none; K. Suresh, none; J. Krishnan, none.
To cite this abstract:Shah L, Press V, Arora V, King A, Meltzer D, Suresh K, Krishnan J. Assessing Impact of Usual Care on Quit Rates 4 Weeks Postdischarge among Hospitalized Smokers. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 134. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/assessing-impact-of-usual-care-on-quit-rates-4-weeks-postdischarge-among-hospitalized-smokers/. Accessed July 22, 2019.