Health system-based care associated with better treatment use and high rates of tobacco abstinence at 3 months post-discharge in hospitalized smokers

1. In this randomized controlled trial of 1409 hospitalized patients who smoke, the health-system-based care intervention, Transitional Tobacco Care Management, produced better treatment use and more tobacco abstinence during the 3 months of treatment post-discharge, compared to referral to a community-based quitline.

2. While the Transitional Tobacco Care Management group had higher rates of past 7-day tobacco abstinence compared to the community-based quitline group, no statistically significance difference in tobacco abstinence rates was observed between both groups at 6 months post-discharge.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Cigarette smoking is a leading cause of preventable death in the United States with almost half a million deaths attributable to smoking annually. More than 3.2 million adults who smoke are hospitalized annually. Illness-related hospital admission can enhance motivation to quit, and offers a unique opportunity within the hospital to initiate smoking cessation interventions with patients. However, evidence supports the long-term effectiveness of smoking cessation interventions only if they are sustained after patient discharge from the hospital. As such, this randomized controlled trial investigated how health systems can most effectively provide smoking cessation treatment to patients after hospital discharge to promote long-term abstinence from tobacco. A total of 1409 hospitalized patients included in this study were randomized to receive either health system-based Transitional Tobacco Care Management (TTCM) or an electronic referral to a community-based quitline (QL). The TTCM intervention provided 8 weeks of nicotine replacement therapy (NRT) at discharge, and 7 automated calls with a hospital-based counselor. The QL intervention sent referrals from the hospital electronic health record to the state QL which offered 5 counselling calls, and a sample of NRT. The primary outcome was biochemically verified past 7-day tobacco abstinence at 6 months post-discharge. At 1 month, and 3 months post-discharge, more participants in the TTCM group use cessation counselling compared with the QL group. This multisite randomized controlled trial is the first trial to compare the health-system-based care model, and the community-based quitline referral model. Limitations to this study were that at 6 months, 26% of participants were lost to follow-up,, and 28% of self-reported biochemical samples to measure tobacco abstinence were not verified.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Sustained care intervention and postdischarge smoking cessation among hospitalized adults: A randomized clinical trial

In-Depth [randomized controlled trial]: This study investigated whether health system-based tobacco cessation treatment after hospital discharge produced higher rates of long-term tobacco abstinence in comparison to a community-based quitline. A total of 1409 participants were included, with 706 randomized to TTCM, and 703 randomized to QL (mean [SD] age, 51.7 [12.6] years; 784 [55.6%] women; mean [SD] 16.4 [10.6] cigarettes/day). At 1 month, and 3 months post-discharge, more TTCM participants used cessation counselling than QL participants (1 month: 245 participants [34.7%] vs 154 participants [21.9%]; 3 months: 248 participants [35.1%] vs 123 participants [17.5%]; P <.001) and pharmacotherapy (1 month: 455 participants [64.4%] vs 324 participants [46.1%]; 3 months: 367 participants [52.0%] vs 264 participants [37.6%; P < .001). At 6 months, a higher proportion of TTCM than QL participants were currently using smoking cessation medication, but not counselling supports. Compared to the QL group, more participants in the TTCM group reported continuous abstinence for 3 months ((RR, 1.30; 95% CI, 1.06-1.58) and point-prevalence abstinence at 1 month (RR, 1.22; 95% CI, 1.08-1.35) and 3 months (RR, 1.23; 95% CI, 1.09-1.37) but not at 6 months (RR, 1.14; 95% CI, 0.99-1.29). At 6 months post-discharge, the biochemically verified point-prevalence abstinence measured was not statistically significantly different between both interventional groups (19.9% vs 16.9%; RR, 1.18; 95% CI, 0.92-1.50).

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