Patient and Physician Perspectives on Treating Tobacco Dependence in Hospitalized Smokers With Substance Use Disorders: A Mixed Methods Study

Abstract

Objective: Individuals with substance use disorders have a high prevalence of smoking cigarettes. Hospitalization represents an opportunity to deliver concurrent treatment for tobacco and other substances. Using a sequential explanatory mixed methods design, we characterized practices and perspectives of patients and physicians about smoking cessation counseling during inpatient addiction medicine consultations. Methods: We abstracted data from 694 consecutive inpatient addiction consult notes to quantify how often physicians addressed tobacco dependence using the guideline-recommended 5As framework. We conducted semi-structured interviews with 9 addiction medicine physicians and 20 hospitalized smokers with substance use disorders. We analyzed transcripts to explore physicians' and patients' perspectives on smoking cessation conversations during inpatient addiction consultations, physician-perceived barriers and facilitators to engaging inpatients in tobacco treatment, and strategies to improve tobacco treatment in this context. Results: 75.5% (522/694) of hospitalized substance use disorder patients were current smokers. Among smokers, 20.9% (109/522) were offered nicotine replacement while hospitalized, but only 5.4% (28/522) received the full guideline-recommended 5As. Patients and physicians reported minimal discussion about tobacco addiction during hospitalization. Physicians cited tobacco not being an immediate health threat and the perception that quitting tobacco is not a priority to patients as barriers, often limiting thorough counseling to patients with smoking-related admissions. Physicians and patients offered strategies to integrate treatment of tobacco dependence and other substances. Conclusions: Inpatient addiction consultations represent a missed opportunity to counsel patients with substance use disorders to quit smoking. System-level changes are needed to coordinate treatment of tobacco and other drug dependence in hospitalized smokers.

Against Medical Advice Discharges in Injection and Non-injection Drug Use-associated Infective Endocarditis: A Nationwide Cohort Study

“…Further, experiences of stigma or poor health literacy may contribute to AMA discharges [11]. Additional strategies to mitigate this outcome include expanding trauma-informed care, linkages, and follow-up with culturally and linguistically competent peers, in-hospital harm reduction services, and treatment of nicotine withdrawal [10,11,30,32,33]. Hospital-based harm reduction including syringe distribution and supervised injection were acceptable to hospitalized patients who inject drugs, but it is not yet known if these approaches improve outcomes, including AMA discharge [34,35].…”

Gaps in Knowledge and Practice in Treating Tobacco Use Among Non-physician Healthcare Professionals and Lay Health Workers in Chicago, Illinois

“…On the other hand, more than half of the health professionals and workers identified that most adult smokers are interested in quitting, and that brief advice from healthcare professionals is a viable method to increase the likelihood of quitting successfully. Despite knowing that brief interventions are effective, the practice of delivering interventions was low, as has been shown in the literature [21][22][23] ; more than half of this sample did not respond to, or skipped, questions regarding the 5As, perhaps indicating either a lack of general knowledge about the 5As or a lack of implementation of the 5As. Even among those who responded, only 58% reported assisting patients with quit attempts and less than a quarter endorsed arranging follow-up.…”

A Taxonomy of Hospital-Based Addiction Care Models: a Scoping Review and Key Informant Interviews

“…Reports with multiple ACS sites [21][22][23][24][25] Boston Medical Center [26][27][28][29][30][31] Massachusetts General Hospital 14,[32][33][34][35] New York City Hospital + Health Systems 36 Oregon Health & Science University 7,8,10,11,12,13,15,[37][38][39][40][41][42] Rush (Chicago) SUIT [43][44][45] University of California San Francisco 46 University of Colorado 47 University of Maryland [48][49][50] Yale University 51 Unspecified site 52,53 Allegheny Health Network 54 ✓…”