A Post-Discharge Smoking-Cessation Intervention for Hospital Patients

Abstract

Introduction Hospitalization provides an opportunity for smokers to quit, but tobacco-cessation interventions started in hospital must continue after discharge to be effective. This study aimed to improve the scalability of a proven effective post-discharge intervention by incorporating referral to a telephone quitline, a nationally available cessation resource. Study design A three-site RCT compared Sustained Care, a post-discharge tobacco-cessation intervention, with Standard Care among hospitalized adult smokers who wanted to quit smoking and received in-hospital tobacco-cessation counseling. Setting/participants A total of 1,357 daily smokers admitted to three hospitals were enrolled from December 2012 to July 2014. Intervention Sustained Care started at discharge and included automated interactive voice response telephone calls and the patient’s choice of cessation medication for 3 months. Each automated call advised cessation, supported medication adherence, and triaged smokers seeking additional counseling or medication support directly to a telephone quitline. Standard Care provided only medication and counseling recommendations at discharge. Main outcome measures Biochemically confirmed past 7–day tobacco abstinence 6 months after discharge (primary outcome); self-reported tobacco abstinence and tobacco-cessation treatment use at 1, 3, and 6 months, and overall (0–6 months). Analyses were done in 2015–2016. Results Smokers offered Sustained Care (n=680), versus those offered Standard Care (n=677), did not have greater biochemically confirmed abstinence at 6 months (17% vs 16%, p=0.58). However, the Sustained Care group reported more tobacco-cessation counseling and medication use at each follow-up and higher rates of self-reported past 7–day tobacco abstinence at 1 month (43% vs 32%, p<0.0001) and 3 months (37% vs 30%, p=0.008). At 6 months, the difference narrowed (31% vs 27%, p=0.09). Overall, the intervention increased self-reported 7-day abstinence over the 6-month follow-up (relative risk, 1.25; 95% CI=1.10, 1.40; p=0.0006). Conclusions A 3-month post-discharge smoking-cessation intervention for hospitalized smokers who wanted to quit did not increase confirmed tobacco abstinence at 6 months but did increase self-reported abstinence during the treatment period (3 months). Real-time linkage of interactive voice response calls to a quitline, done in this trial to increase scalability of a previously proven cessation intervention, demonstrated short-term promise but did not sustain long-term intervention effectiveness. Clinical trial registration NCT01714323

Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping HAND 4 randomized controlled trial

“…The rate ratio (1.39 = 0.23/0.165) is clinically meaningful and resembles the ratio found in meta-analysis of smoking cessation interventions for hospitalized patients [46]. We conservatively estimate the eReferral abstinence rate from the Helping HAND 2 trial (17% and 16%) [10] because participants in both conditions of that trial were referred to a quitline. For PTCM, the intervention resembles that of Helping HAND 1, where a 25% abstinence rate was observed [8], and we conservatively estimate a 23% abstinence rate.…”

“…The multi-component Personalized Tobacco Care Management (PTCM) model builds on the Sustained Care model tested in our previous trials [8][9][10][11]28]. It aims to ensure that smoking cessation support and pharmacotherapy, the core components of effective tobacco dependence treatment [5], are reliably delivered to participants following hospital discharge.…”

“…The second trial, Helping HAND 2 [10,11], aimed to improve the scalability of Sustained Care intervention by transferring the task of delivering post-discharge counseling from hospital staff to tobacco treatment specialists at a state quitline. The revised Sustained Care model increased self-reported tobacco abstinence for 3 months after discharge, compared to standard care, but produced no difference in validated tobacco abstinence rates 6 months after discharge (17% vs. 16%) [10]. In a posthoc analysis, participants reported that the linkage from automated calls to quitline counselors was cumbersome, and fewer participants used post-discharge counseling in Helping HAND 2 than in Helping HAND 1 [11,12].…”

Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials

“…The HH2 intervention improved smoking cessation rates at 3 months, but 6-month results did not differ. 12 A possible explanation for this difference is that in HH2, fewer smokers who requested additional counseling during an IVR call actually reached a counselor. 12 Contrary to expectation, connecting smokers directly to a community-based quitline was cumbersome and was less successful in engaging smokers in counseling than having hospital-based staff make a separate call to smokers.…”

Examining the effects of illicit drug use on tobacco cessation outcomes in the Helping HAND 2 randomized controlled trial

“…We examine data from a multi-center randomized controlled trial of a smoking intervention for the general population of hospitalized smokers. It demonstrated the efficacy of a post-discharge intervention in improving self-reported tobacco abstinence rates at 1 and 3 months compared to standard care (Rigotti et al, 2016). We hypothesized that participants with recent illicit drug use would have lower quit rates than participants not using illicit drugs.…”