Post-hospitalization intervention strategy yielded higher smoking cessation rates

Adult smokers recently released from the hospital achieved higher 6-month smoking cessation rates when they followed a post-discharge strategy compared with standard recommendations, according to results of a randomized trial.

“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,” Nancy A. Rigotti, MD, of Massachusetts General Hospital, and colleagues wrote. “Simultaneously, their illness — especially if related to tobacco use — can enhance their motivation to quit.”

The analysis included 397 patients (mean age, 53 years) who were hospitalized at Massachusetts General Hospital. Rigotti and colleagues randomly assigned patients to a sustained care intervention — which included automated telephone calls and free medication — or standard recommendations for smoking cessation.

All patients were current daily smokers — defined as those who smoked at least one cigarette per day in the month prior to hospitalization — and they all received smoking cessation counseling while hospitalized.

All study participants expressed an intention to try to quit smoking after discharge, and they agreed to take smoking cessation medication. Forty-five percent of participants were discharged with a diagnosis of a smoking-related disease.

Researchers randomly assigned patients to the sustained care intervention (n=198) or standard care (n=199). Patients in the sustained care group received a 30-day supply of any FDA-approved smoking cessation drug. The patient and an assigned smoking cessation counselor chose the drug during the hospital stay.

Additionally, patients assigned the sustained intervention received five automated interactive voice-response telephone calls. The calls — made at 2, 14, 30, 60 and 90 days following hospital discharge — provided messages of support and encouragement, offered advice on medication compliance, and offered medication refills. Participants also were also able to request a call back from a counselor for additional support or guidance.

Patients in the standard care group received a recommendation for a specific smoking cessation medication at discharge, and were advised to call a free telephone hotline for smoking cessation support.

Biochemically confirmed, 7-day point prevalence tobacco abstention at 6 months after hospitalization served as the study’s primary outcome.

At each follow-up assessment, patients in the sustained care group had utilized more counseling services and medication than those in the standard care group, results showed. Additionally, a higher proportion of those in the sustained care group achieved the outcome of biochemically validated 6-month tobacco abstinence (26% vs. 15%; RR=1.71; 95% CI, 1.14-2.56).

“The intervention aimed to sustain the tobacco cessation treatment that had begun in the hospital,” Rigotti and colleagues wrote. “It succeeded in improving the use of both counseling and pharmacotherapy by smokers after discharge, and it increased by 71% the proportion of patients with biochemically confirmed tobacco abstinence six months after discharge.”

Researchers calculated a RR of 1.55 (95% CI, 1.03-2.21) for 7-day tobacco abstinence.

Participants in the sustained care group also had higher self-reported rates of continuous abstinence at 6 months after discharge (27% vs. 16%; RR=1.7; 95% CI, 1.15-2.51).

“The intervention appeared to be effective across a broad range of smokers and provided high-value care at relatively low cost,” the researchers wrote. “These findings, if replicated, suggest a translatable, low-cost approach to achieving sustained smoking cessation after a hospital stay.”

Disclosure: The researchers report consultant relationships with, as well as royalties, and grant contributions from, Alere Wellbeing Inc., CVS Inc., Pfizer and UpToDate.