Patient survey examining the experience of care of a hospital-based opt-out tobacco dependency treatment service (the CURE Project)

Abstract

IntroductionTreating tobacco dependency in patients admitted to hospital is a key priority in the National Health Service long-term plan. This service evaluation assessed the perception, needs and experience of care within an opt-out hospital-based tobacco dependency treatment service (the Conversation, Understand, Replace, Experts and Evidence Base (CURE) team) in North-West England.MethodsA survey was offered to all eligible patients between 1 July 2020 and 30 September 2020. Eligibility criteria were adult patients identified as an active smoker being approached by the CURE team as part of the standard opt-out service model, on a non-covid ward without a high suspicion of COVID-19 infection and able to read and write in English.Results106 completed surveys were evaluated. Participants demonstrated high levels of tobacco dependency with an average of 37 years smoking history and 66% describing the onset of cravings within 30 min of hospital admission. The average number quit attempts in the previous 12 months was 1.3 but only 9% had used the most effective National Institute for Health and Care Excellence (NICE) recommended treatments. 100% felt the opt-out service model was appropriate and 96% stated the treatment and support they had received had prompted them to consider a further quit attempt. 82% of participants rated their experience of care as 9/10 or 10/10. Participants wanted a broad range of support post discharge with the most popular option being with their general practitioner. 66% and 65% of participants would have been interested in a vaping kit as stop smoking intervention and support vaping-friendly hospital grounds respectively.ConclusionThese results suggest this hospital-based, opt-out tobacco dependency treatment service delivers high-quality experience of care and meets the needs of the patients it serves. It also highlights the opportunity to enhance outcomes by providing access to NICE recommended most-effective interventions (varenicline, vaping and combination nicotine replacement therapy) and providing flexible, individualised discharge pathways.

Implementation, enrollment, and engagement in an opt‐out telehealth pharmacist‐assisted tobacco treatment program for patients seen in oncology outpatient clinics

“…The United States Department of Health and Human Services recently requested information on strategies to broaden the delivery of evidence‐based smoking cessation treatments to those who continue to currently smoke cigarettes 35 . The findings from this study contribute to the increasing evidence demonstrating the feasibility of using electronic health records and opt‐out strategies to identify and proactively deliver smoking cessation treatments to patients in health care settings 15–30 . Overall, opt‐out smoking cessation treatment was delivered to 45.5% of currently smoking patients referred to the TTP.…”

“…35 The findings from this study contribute to the increasing evidence demonstrating the feasibility of using electronic health records and opt-out strategies to identify and proactively deliver smoking cessation treatments to patients in health care settings. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Overall, opt-out smoking cessation treatment was delivered to 45.5% of currently smoking patients referred to the TTP. Importantly, among 1967 patients reached and eligible for TTP enrollment, only 23.3% (458 of 1967) affirmatively refused enrollment.…”

“…The published literature includes many informative examples of how electronic health records can be used to identify patients who smoke and support smoking cessation interventions for patients with cancer and other types of patients seen in health care settings 15–30 . As a result of this literature and feedback received from our patients, the HCC instituted an opt‐out telehealth pharmacy‐assisted tobacco treatment program (TTP) as our primary mode for offering patients smoking cessation support.…”

“…13,14 The published literature includes many informative examples of how electronic health records can be used to identify patients who smoke and support smoking cessation interventions for patients with cancer and other types of patients seen in health care settings. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] As a result of this literature and feedback received from our patients, the HCC instituted an opt-out telehealth pharmacyassisted tobacco treatment program (TTP) as our primary mode for offering patients smoking cessation support. The TTP includes 4 components: (1) screening of electronic health records to identify patients who currently smoke and who were seen across 43 HCC outpatient oncology clinics; (2) opt-out referral of patients to the TTP for those who have not previously been offered the TTP in the past 6 months; (3) telephone outreach to patients to offer them the opportunity to enroll in the TTP which consists of up to 4 counseling calls and free smoking cessation nicotine replacement therapy medications mailed to their home for those deemed eligible for pharmacotherapy; and (4) follow-up evaluation which involves recontacting a random sample of referred patients 4 to 12 months after referral to the TTP to independently assess smoking status and collect feedback useful for ongoing quality improvement.…”