Ottawa Model For Smoking Cessation Research Articles

Economic evaluation of a hospital-initiated intervention for smokers with chronic disease, in Ontario, Canada

IntroductionCigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness...

Implementation of a Smoking Cessation Pilot Project within the Department of Radiation Oncology at the Stronach Regional Cancer Centre

The process proposed for the Stronach Regional Cancer Centre Smoking Cessation Pilot Project is to create a continuum of supportive and inter-professional care through the patient’s treatment journey from initial consult through to post-treatment follow-up. Similar to the Ottawa Model for Smoking Cessation, the smoking status of each patient is identified and documented through a universal electronic tobacco assessment tool. Next, based on willingness and/or readiness to quit, patients are provided with appropriate smoking cessation resources and strategies including information on Nicotine Replacement Therapies.

017 Randomized trial of an automated telephone follow-up system for smoking cessation in smokers with CHD

Smokers with CHD benefit from cessation counseling in hospital only if it continues after discharge. A randomized controlled trial was conducted to determine if continuous abstinence from smoking would be higher 26 and 52 weeks after discharge in smokers who received interactive voice-response (IVR) mediated telephone follow-up and triage to nurse counseling compared to those receiving standard care. A total of 440 smokers (≥ 5 cigarettes/d) hospitalized with CHD at the University of Ottawa Heart Institute were randomized to either standard care (SC) or IVR. Standard care included: in-hospital nurse counseling; nicotine replacement therapy (NRT) during hospitalization; and a recommendation for ongoing NRT following discharge. Participants in the IVR group received standard care and also received automated telephone calls 3, 14, 30, 60, 90, 120, 150 and 180 days after discharge. During the call, the IVR system posed a series of questions concerning smoking status, confidence in staying smoke-free, and use of cessation medications. If the patient identified that they had resumed smoking or indicated that their confidence in remaining smoke-free was low, they were contacted by a nurse-counselor who provided additional assistance. The primary outcome was self-reported continuous abstinence 26 and 52 weeks after hospital discharge. Four hundred and one participants were eligible for inclusion in the analysis. Continuous abstinence was significantly higher in the IVR compared to the SC group at 26 weeks (38.7% vs. 29.5%; adjusted OR = 1.58; 95% CI, 1.04-2.42; P= 0.034). There was also a trend for higher continuous abstinence at 52 weeks favouring the IVR group (35.6% vs. 28.6%; adjusted OR = 1.45; 95% CI, 0.94-2.22; P= 0.093). IVR-mediated telephone follow-up and triage to nurse counseling lead to statistically and clinically significant increases in abstinence after discharge among smokers hospitalized with CHD. IVR offers an efficient way to direct limited hospital resources to smokers in need of ongoing support after discharge; the approach used in this study is a fundamental component of the Ottawa Model for Smoking Cessation.

198 Identification of smoking status among hospitalized cardiac patients: Are we doing enough to promote smoking cessation?

Smoking has adverse prognostic consequences in patients with established coronary artery disease (CAD), including greater subsequent rates of non-fatal myocardial infarctions, recurrent coronary events, restenosis and all-cause mortality. Smoking cessation is the most effective lifestyle modification in the management of patients with CAD. Clearly, patient smoking status should be screened systematically in inpatient cardiac settings, and smoking patients should be offered evidence-based cessation therapies. This study investigated cardiac outpatients' recall of: (1) being asked about their smoking status, and (2) among smokers, their recall of being offered treatment while hospitalized. In this cross-sectional substudy, 155 consenting CAD outpatients referred to 1 of 5 Ontario cardiac rehabilitation (CR) programs were provided a self-report survey at their first CR intake visit. Patients were asked to report their current smoking status, whether they recalled being asked about their smoking status while in-hospital, whether they were offered treatment, and the nature of treatment offered. A descriptive examination was performed. Of all participants, 9 (5.8%) reported they had never smoked. 126 (81.8%) reported they had quit smoking (24.62 ± 13.87 years). Finally, 19 (12.3%) reported being current smokers (Mean = 13.78 ± 10.67 cigarettes/day for 33.8 ± 12.80 years). Of all participants, 25 (16.2%) reported not being asked in hospital whether or not they smoked. This did not differ by time since hospital discharge (mean 10.54 ± 14.18, median 6, weeks P = 0.641). Of cardiac patients that currently smoked, 2 (10.5%) did not recall being asked if they smoked. When asked whether a healthcare provider offered them treatment or counseling to assist them in smoking cessation, overall 41 (26.6%) responded affirmatively. Of the current smokers, 11 (57.9%) reported being offered treatment. Specifically, 5 (50%) were offered nicotine replacement therapy, 4 (40%) were offered counselling, and 1 (10%) was offered Champix. Approximately 1/6 of cardiac patients do not recall being asked about their smoking status while hospitalized, with a slightly higher rate of recall among smokers (10%). Moreover, approximately 40% of smoking cardiac patients do not recall being offered smoking cessation treatment or counseling by a healthcare provider. These findings may be explained by patient recall failure, however clearly we should be striving to achieve universal screening of all smoking cardiac patients, and application of evidence-based strategies to promote cessation, such as the Ottawa Model for Smoking Cessation.

Smoking cessation for hospitalized smokers: An evaluation of the “Ottawa Model”

Interventions for hospitalized smokers can increase long-term smoking cessation rates. The Ottawa Model for Smoking Cessation (the "Ottawa Model") is an application of the "5 A's" approach to cessation, customized to the hospital setting. This study evaluated the impact of implementing the Ottawa Model in 9 hospitals in eastern Ontario. The RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was used to evaluate the intervention. Trained outreach facilitators assisted 9 hospitals to implement the Ottawa Model; program delivery was then monitored over a 1-year period using administrative data and data from a follow-up database. A before-and-after study was conducted to gauge the effect of the Ottawa Model program on cessation rates 6 months after hospitalization. Self-reports of smoking cessation were biochemically confirmed in a random sample of patients, and all cessation rates were corrected for potential misreporting. Sixty-nine percent of the expected number of smokers received the Ottawa Model intervention. Controlling for hospital, the confirmed 6-month continuous abstinence rate was higher after, than before, introduction of the Ottawa Model (29.4% vs. 18.3%; odds ratio = 1.71, 95% CI = 1.11-2.64; Z = 2.43; I(2) = 0%; p = .02). The intervention was more likely to accomplish counseling for smokers than delivery of medications or postdischarge follow-up. Attitudinal, managerial, and environmental challenges to program implementation were identified. Trained outreach facilitators successfully implemented the Ottawa Model in 9 hospitals leading to significantly higher long-term cessation rates. The public health implications of systematic cessation programs for hospitalized smokers are profound.