Tobacco Cessation |

Inpatient Smoking Cessation Counseling and Pharmacotherapy: A Practice Gap FREE TO VIEW

Sonam Puri, MBBS; Shireen Mirza, MD; Eric C. DeRycke, MPH; Lori Bastian, MD
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University of Connecticut Health Center, Farmington, CT

Chest. 2015;148(4_MeetingAbstracts):1074A. doi:10.1378/chest.2270963
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SESSION TITLE: Tobacco Cessation and Prevention Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Hospitalization provides a unique opportunity to address smoking cessation. Prior research indicates that an effective inpatient smoking cessation intervention increases odds of stopping smoking after discharge by 65%.

METHODS: We conducted a retrospective chart review of 900 patients discharged from the University of Connecticut Health Centers' inpatient medicine service between July 2014 and January 2015. Charts were reviewed for demographic characteristics, diagnoses, length of stay, smoking status at admission, receipt of smoking cessation counseling and pharmacotherapy.

RESULTS: Prevalence of smoking in our older (age ≥ 65: 57.6%), mostly white (84.2%) inpatient cohort was 10.6%. Despite an existing nurse-initiated tobacco screening and counseling protocol, 49 of 96 (51%) smokers did not receive counseling. Patients who were counseled were more likely to receive pharmacotherapy both as an inpatient (46% vs. 22%, p=0.02), and at the time of discharge (11% vs. 2%, p=0.11). No age, gender or race disparities were detected in counseling or pharmacotherapy rates. The majority of pharmacotherapy provided was nicotine patches.

CONCLUSIONS: This is one of the first studies of its kind to evaluate smoking cessation counseling and pharmacotherapy in a general inpatient medicine unit. Our results indicate the need for a formal communication protocol between nurses and resident providers to effectively address smoking cessation in the inpatient setting. Moreover, our study also highlights knowledge gap among resident physicians regarding pharmacotherapy options for smoking cessation.

CLINICAL IMPLICATIONS: Given the minimal cost and strong benefits of smoking cessation, healthcare facilities should prioritize evaluation of current inpatient smoking cessation programs and provider knowledge of alternative therapies. An added incentive for an effective program would be meeting criteria for Centers for Medicare and Medicaid Services' meaningful use of electronic health records, and the Joint Commission’s tobacco treatment measure set. Based on our finding of gaps in knowledge and inter-professional communication around smoking cessation counseling and pharmacotherapy, the next step is to focus on improving processes via targeting physician education and nurse-provider communication.

DISCLOSURE: The following authors have nothing to disclose: Sonam Puri, Shireen Mirza, Eric C. DeRycke, Lori Bastian

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