Hospital‐based tobacco cessation counseling is critical, especially among African Americans, who suffer a disproportionate burden of tobacco‐related disease. Recently updated cessation guidelines are available, and quality measures for counseling are tied to physician reimbursement. Yet previous research showed only 10% of patients with tobacco‐related disease quit smoking postdischarge. This study aimed to understand barriers to providing guideline‐based care for inpatient smokers.
Current smoking inpatients were identified and interviewed at admission about smoking behaviors and cessation barriers. In addition, providers were surveyed regarding barriers to following guidelines for tobacco cessation. At discharge, interns, residents, and nurses caring for enrolled smokers were interviewed regarding their awareness of tobacco cessation guidelines, any tobacco cessation guideline‐based care they offered to the patient, and their assessments of individual patient readiness to quit.
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, and 77 (34%) had a discharge diagnosis of a tobacco‐related illness. A total of 196 provider surveys were completed; these included 102 surveys of interns and residents rotating on the general medicine service and 94 surveys of medicine ward nurses caring for enrolled smokers at discharge. Of the 102 house staff surveys, physicians reported being aware that the patient was a smoker 77% of the time and offering tobacco cessation advice to these smokers 60% of the time. This advice consisted of at least 10 minutes of counseling only 18% of the time. House staff reported referring known smokers to an onsite tobacco cessation program only 10% of the time. Similarly, nurses were aware a patient was a smoker 77% of the time. In these cases, nurses reported they gave advice to quit 59% of the time and spent at least 10 minutes counseling patients on quitting only 13% of the time. They referred patients to an onsite tobacco cessation clinic in only 13% of cases. All providers cited multiple reasons for lack of counseling and lack of referral to a post‐discharge clinic including time constraints, a lack of prioritization, a belief that individual patients were not ready to quit, and a lack of awareness of tobacco cessation guidelines or postdischarge options.
Hospitalization is a missed opportunity to counsel on tobacco cessation, with few patients quitting postdischarge and few providers delivering evidence‐based care. Despite quality measures for assessing tobacco use and advising patients to quit, health care providers face many challenges to implementing guideline‐based tobacco cessation care in the hospital. Quality measures may need to be expanded to further promote the use of evidence‐based methods. Health care providers may benefit from training and support in promoting tobacco cessation at all stages of the care continuum.
L. M. Shah ‐ none; V. Press ‐ none; J. Krishnan ‐ none; K. Suresh ‐ none; V. Arora ‐ none; D. Meltzer ‐ none
To cite this abstract:Shah L, Press V, Krishnan J, Suresh K, Arora V, Meltzer D. Up in Smoke! Treating Tobacco Addiction in the Hospital and Policy Implications. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 111. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/up-in-smoke-treating-tobacco-addiction-in-the-hospital-and-policy-implications/. Accessed July 23, 2019.