Hospital-sponsored stop-smoking programs for inpatients that include follow-up counseling for longer than one month significantly improve patients’ ability to stay smoke-free. An analysis of clinical trials of programs offered at hospitals around the world finds that efforts featuring long-term support can increase participants’ chances of success by 65 percent. The study — led by Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital (MGH) — appears in the Oct. 13 Archives of Internal Medicine and is one of several articles focused on smoking.
“While nobody looks forward to a hospital stay, it can really have an extra benefit for smokers” says Rigotti. “But this is only if the hospital helps them quit with counseling during and after their hospital stay. Hospitals really need to step up to the plate and offer this type of service routinely, and it also should be reimbursed by payers.”
Entering the hospital poses a special challenge for smokers because all U.S. hospitals are now smoke-free, but it also can offer those ready to quit an important opportunity. Both the inability to smoke during their hospital stay and a determination to recover from their illness, particularly if it is tobacco-related, can encourage smokers to begin a serious effort to kick the habit. Many hospitals offer stop-smoking help to their patients, but questions remain about whether those programs are successful. The current study analyzed the results of 33 clinical trials of hospital-based programs in nine countries — three at MGH — conducted between 1999 and 2007.
Analyzing hospital-based efforts according to their intensity — a single brief smoking-related contact, one or more extended contacts during hospitalization, hospital contact plus a month or less of post-discharge telephone support, and hospital contact followed by more than a month of post-discharge support — revealed that only programs with the highest intensity level were more successful than usual care in helping patients quit for six months or longer.
Including nicotine replacement products further increased patients’ quit rates — probably by both relieving nicotine withdrawal symptoms and helping patients stay off cigarettes once they leave the hospital, the researchers note — but data were not sufficient to assess the impact of pharmaceuticals like bupropion and varenicline. Although the success rate for patients admitted with cardiovascular disease was a bit higher, intensive counseling was successful for all hospitalized smokers, regardless of their diagnosis.
“One of the hospital quality-of-care standards instituted by the Joint Commission on Accreditation of Healthcare Organizations [JCAHO] and the Centers for Medicare & Medicaid Services [CMS] focuses on tobacco. It measures what percentage of patients with three smoking-related illnesses receive stop-smoking counseling and assistance during their hospital stay,” notes Rigotti, who is a professor of medicine at Harvard Medical School. “Our analysis supports the measure but suggests that it be expanded to include all hospitalized smokers and strengthened to assess whether assistance continues after discharge, which is necessary for the effort to be effective.”
The program offered at MGH begins by automatically flagging patients’ smoking status upon admission and giving each patient who smokes a booklet addressing how to use their stay to help them quit smoking. Smoking-cessation counselors visit with patients during their hospitalization and call them after discharge to check on their progress and offer further assistance. Because of this program and other stop-smoking efforts, the hospital increased its JCAHO/CMS smoking measure score to 100 percent.
The information analyzed in this study came from the trial register of the Cochrane Tobacco Addiction Review Group, which is supported by the National Health Service of the United Kingdom. Additional support came from the U.S. National Heart, Lung and Blood Institute. The study’s co-authors are Marcus Munafo, University of Bristol, England, and Lindsay Stead, Cochrane Tobacco Addiction Review Group.