Sustained Care Intervention and Postdischarge Smoking Cessation Among Hospitalized Adults: A Randomized Clinical Trial
Can smoking cessation rates be sustained long-term after hospital discharge?
The Helping HAND (Hospital-initiated Assistance for Nicotine Dependence) trial was a randomized clinical trial, which compared sustained care (including a post-discharge tobacco cessation intervention) with usual care among hospitalized smokers who reported smoking daily and who wanted to quit smoking after discharge. Participants received a tobacco dependence intervention in the hospital. Of the 92% of eligible patients, 44% of screened patients enrolled. The study was conducted from August 2010 through November 2012, at Massachusetts General Hospital. The intervention arm received automated interactive voice response telephone calls and their choice of free smoking cessation medication (any type approved by the US Food and Drug Administration) for up to 90 days. The automated telephone calls promoted cessation, provided medication management, and triaged smokers for additional counseling. Standard care participants received recommendations for post-discharge pharmacotherapy and counseling. The primary outcome was biochemically confirmed past 7-day tobacco abstinence at 6-month follow-up after discharge from the hospital; secondary outcomes included self-reported tobacco abstinence.
A total of 397 smokers (mean age, 53 years; 48% male; 81% non-Hispanic white) were enrolled. Follow-up survey completion rates were 90% at 1 month, 83% at 3 months, and 81% at 6 months, with no statistically significant difference by study group. Participants lost to follow-up were younger (mean age of 50 years vs. 53 years; p = 0.04), but did not differ by sex, number of cigarettes/day, or admission to the cardiac service. Smokers randomly assigned to sustained care (n = 198) used more counseling and more pharmacotherapy at each follow-up assessment than those assigned to standard care (n = 199). Biochemically validated 7-day tobacco abstinence at 6 months was higher with sustained care (26%) than with standard care (15%) (relative risk [RR], 1.71; 95% confidence interval [CI], 1.14-2.56; p = 0.009; number needed to treat, 9.4 [95% CI, 5.4-35.5]). Sustained care also resulted in higher self-reported continuous abstinence rates for 6 months after discharge (27% vs. 16% for standard care; RR, 1.70; 95% CI, 1.15-2.51; p = 0.007).
The investigators concluded that among hospitalized adult smokers who wanted to quit smoking, a post-discharge intervention providing automated telephone calls and free medication resulted in higher rates of smoking cessation at 6 months compared with a standard recommendation to use counseling and medication after discharge. These findings, if replicated, suggest an approach to help achieve sustained smoking cessation after a hospital stay.
Long-term abstinence from smoking is critical to have an impact on cardiovascular disease event reduction. Further research related to long-term smoking cessation programs is warranted based on these current data.
Keywords: Risk, Follow-Up Studies, United States Food and Drug Administration, Counseling, Confidence Intervals, Tobacco Use Disorder, Smoking Cessation, Hospitals, General, Length of Stay
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