Evaluation of a Systems-Based Tobacco Cessation Program Using Bedside Volunteers

Abstract

Introduction Hospitalization and post-discharge provide an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based tobacco cessation program, delivered by volunteers to the bedside with post-discharge referral to Quitline services. Patient characteristics associated with Quitline uptake and cessation were assessed. Methods Between February and November 2016, trained hospital volunteers approached inpatient tobacco users on six pilot units. Volunteers shared a cessation brochure and used the ASK-ADVISE-CONNECT model to connect ready to quit patients to the Delaware Quitline via fax-referral. Volunteers administered a follow-up survey to all admitted tobacco users via telephone or email at 3-months post-discharge. Results Of the 743 admitted tobacco users, 531 (72%) were visited by a volunteer, and 97% (531/547) of those approached, accepted the visit. Over one-third (201/531; 38%) were ready to quit and fax-referred to the Quitline, and 36% of those referred accepted Quitline services. At 3 months post-discharge, 37% (135/368) reported not using tobacco in the last 30 days; intent-to-treat cessation rate was 18% (135/743). In a multivariable regression model of Quitline fax-referral completion, receiving nicotine replacement therapy (NRT) during hospitalization was the strongest predictor (odds ratios [OR] = 1.97; 95% confidence interval [CI] = 1.34 to 2.90). In a model of 3-month cessation, receiving Quitline services (OR = 3.21, 95% CI = 1.35 to 7.68) and having coronary artery disease (OR = 2.28; 95% CI = 1.11 to 4.68) were associated with tobacco cessation, but a volunteer visit was not. Conclusions An “opt-out” tobacco cessation service using trained volunteers is feasible for connecting patients to Quitline services. Implications This study demonstrates the feasibility of a systems-based approach to link inpatients to evidence-based treatment for tobacco use. This model used trained bedside volunteers to connect inpatients to a state-funded Quitline after discharge that offers free cessation treatment of telephone coaching and cessation medications. Receiving NRT during hospitalization positively impacted Quitline referral, and engagement with Quitline resources was critical to tobacco abstinence post-discharge. Future work is needed to evaluate the cost-effectiveness and sustainability of this volunteer model.

How can hospitals change practice to better implement smoking cessation interventions? A systematic review

“…Table 3 presents an overview of each study 36‐98 . A summary of the characteristics of the 56 studies is presented in Table 4.…”

“…Table 6 presents an overview of the groups, listing the implementation strategy for each group and subsequently providing a breakdown of each implementation outcome (acceptability, adoption, appropr iateness, cost, feasibility, fidelity, penetration, and sustainability). 31,36,37,[39][40][41][42][43][44][45][46][47][48][49][50][51][52]56,58,[60][61][62][64][65][66][67][68][69][70][71]73,75,76,82,[86][87][88][89]91,92,[94][95][96] A more comprehensive list of implementation outcomes for all included studies is presented in Supporting Table 2. A summary of results is presented below:…”

“…(10 studies) 37,[46][47][48]52,56,57,71,87,92,97 had an average study period of 1.7 years. These studies had dedicated staff to deliver smoking-cessation interventions, and the most common outcomes assessed were cost (5 studies), penetration (8 studies), and sustainability (4 studies).…”

“…Results for feasibility were mixed: One study found referrals were easier than expected (Campbell 2016, 47 2017 48 ), another noted insufficient time (Duffy 2010 52 ), and another found resource limitations (Taylor 2020 92 ).…”

Factors associated with receipt of the 5As model of brief intervention for smoking cessation among hospitalized patients

“…Some research has identified barriers to implementing the full 5As model [48,49], and a shorter 3As ‘ask–advise–refer/act/connect’ has been suggested [34,50–52]. These shorter models have been used mainly in ambulatory settings [52] and with a focus on referring patients to telephone Quitline services [53]. The preponderance of knowledge on this topic suggests that delivery of all the components of the 5As model is associated with a greater use of cessation treatments [22].…”