Abstract
BackgroundHospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates. Use of smoking cessation medications following discharge may further increase quit rates. This study aims to identify individual, smoking-related and hospitalization-related predictors of engagement in three different steps in the smoking cessation pharmacotherapy utilization process: 1) receiving medications as inpatient, 2) being discharged with a prescription and 3) using medications at 1-month post-hospitalization, while accounting for associations between these steps.MethodsStudy data come from a clinical trial (N = 1054) of hospitalized smokers interested in quitting who were randomized to recieve referral to a quitline via either warm handoff or fax. Variables were from the electronic health record, the state tobacco quitline, and participant self-report. Relationships among the predictors and the steps in cessation medication utilization were assessed using bivariate analyses and multivariable path analysis.ResultsTwenty-eight percent of patients reported using medication at 1-month post-discharge. Receipt of smoking cessation medications while hospitalized (OR = 2.09, 95%CI [1.39, 3.15], p < .001) and discharge with a script (OR = 4.88, 95%CI [3.34, 7.13], p < .001) were independently associated with medication use at 1-month post-hospitalization. The path analysis also revealed that the likelihood of being discharged with a script was strongly influenced by receipt of medication as an inpatient (OR = 6.61, 95%CI [4.66, 9.38], p < .001). A number of other treatment- and individual-level factors were associated with medication use in the hospital, receipt of a script, and use post-discharge.ConclusionsTo encourage post-discharge smoking cessation medication use, concerted effort should be made to engage smokers in tobacco treatment while in hospital. The individual and hospital-level factors associated with each step in the medication utilization process provide good potential targets for future implementation research to optimize treatment delivery and outcomes.Trial registrationNumber: NCT01305928.Date registered: February 24, 2011.
Highlights
Hospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates
Medications started during hospital stays are effective for smoking cessation; a Cochrane review found that adding nicotine replacement therapy (NRT) to supportive inpatient intervention increased quit rates by 54% [2], and a recent clinical trial found that free NRT provided at discharge significantly increased quit rates independent of behavioral support [3]
Of the participants who reported using pharmacotherapy at 1-month post-discharge, 60.5% were discharged with a prescription for medication and 43.6% received medication while hospitalized
Summary
Hospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates. Use of smoking cessation medications following discharge may further increase quit rates. The rate of smoking among hospitalized patients (40%) exceeds that of the general population (13%) [1], suggesting that inpatient smokers are an important target for tobacco treatment intervention. Interventions that start in hospital and provide supportive contact for at least one-month post discharge increase quit rates by 37% [2]. Medications started during hospital stays are effective for smoking cessation; a Cochrane review found that adding nicotine replacement therapy (NRT) to supportive inpatient intervention increased quit rates by 54% [2], and a recent clinical trial found that free NRT provided at discharge significantly increased quit rates independent of behavioral support [3]. Freund et al found that only 13% of hospital providers reported they offered or advised the use of cessation medications [4]
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