Hospitalization affords a unique opportunity to assist smokers with a cessation attempt. Abstinence is automatic, motivation high, and the cessation message can be delivered multiple times. Inpatient smoking cessation programs (ISCPs) are more successful than ambulatory programs with 1 year abstinence rates as high as 70%. We report our preliminary experience with an ISCP at our 450 bed community hospital.
Since 7/04, smokers have been identified by the hospital’s case managers during their AM rounds. A daily roster is faxed to the Smoking Cessation Center (SCC) and patients are seen that day by the counselors. Those who accept counseling are given written materials and receive a 5 -10 minute message based on the DHHS guidelines (1996). Physicians caring for smokers are encouraged to prescribe nicotine patches (NRT) and/or bupropion. We attempt monthly contact with patients agreeing to follow-up. Demographic, clinical and follow-up data are entered into an electronic database. A stepwise logistic regression model was used to analyze the data presented below.
In the first 6 months since inception, 421 patients were seen by the ISCP and 129 (30.6%) were contacted 1-6 months after hospitalization. Sixty-eight of 129 (46.5%) remained abstinent at 1-6 months. NRT and/or bupropion were used by 13 patients (13.1%) during 1 or more months after discharge. In univariate analyses, Caucasian patients and those admitted with cardiovascular diseases had a greater likelihood of remaining abstinent (OR=2.70, 95% CI 1.132-6.455, p=.025 and OR=2.308, 95% CI 1.009-5.276, p=.047 respectively). Multivariate analysis confirmed these as independent predictors of abstinence. Age, gender, pack-years of smoking, and lung disease were not predictive.
Our data, although preliminary, suggest that ISCPs are highly effective in assisting patients in cessation attempts. As previously reported, smokers with cardiovascular diseases are most likely to benefit from this intervention.
ISCPs offer smokers the prospect of a successful quit attempt. This opportunity to provide repetitive, expert cessation guidance should not be missed.
Kathy Garrett-Szymanski, None.