Among hospitalized adult smokers who wanted to quit, a postdischarge intervention that included automated telephone calls and free medication resulted in higher sustained smoking cessation rates at six months than standard postdischarge advice to use smoking cessation medication and counseling, according to a study in the August 20 issue of JAMA.
Cigarette smoking is the leading preventable cause of death in the United States. For the nearly 4 million smokers hospitalized each year, a hospital stay offers a good opportunity to quit smoking because all hospitals are now smoke-free, requiring patients to abstain temporarily from tobacco use. The major challenge for hospitals in providing evidencebased care is identifying how to sustain tobacco treatment after discharge, according to background information in the article.
Nancy A. Rigotti, M.D., of Massachusetts General Hospital, Boston, and colleagues randomly assigned 397 hospitalized daily smokers (average age, 53 years) who wanted to quit smoking after discharge to sustained or standard tobacco treatment care. Sustained care participants (n = 198) received automated interactive voice response telephone calls and their choice of free smoking cessation medication (any type approved by the U.S. 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 (n = 199) received recommendations for postdischarge pharmacotherapy and counseling.
The researchers found that more participants in the sustained care group than in the standard care group achieved the primary outcome of biochemically confirmed past 7-day tobacco abstinence (using saliva samples to measure a nicotine metabolite) at 6-month follow-up (26 percent vs 15 percent, respectively). Sustained care also resulted in higher self-reported continuous abstinence rates for 6 months after discharge (27 percent vs 16 percent for standard care).
"[This] trial demonstrated the effectiveness of a program to promote long-term tobacco cessation among hospitalized cigarette smokers who received an inpatient tobacco dependence intervention and expressed an interest in cessation treatment after discharge. The intervention aimed to sustain the tobacco cessation treatment that had begun in the hospital. It succeeded in improving the use of both counseling and pharmacotherapy by smokers after discharge, and it increased by 71 percent the proportion of patients with biochemically confirmed tobacco abstinence 6 months after discharge, which is a standard measure of long-term smoking cessation. The intervention appeared to be effective across abroad range of smokers and provided high-value care at a relatively low cost," the authors write.
"These findings, if replicated, suggest a translatable, low-cost approach to achieving sustained smoking cessation after a hospital stay."
(doi:10.1001/jama.2014.9237; Available pre-embargo to the media at http://media.
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For related articles on this subject, please see our tobacco control theme issue from earlier this year, available at this link.