Smoking Cessation - Best Practices, Hospital - VHA Public Health Strategic Healthcare Group

While only a minority of VA patients is hospitalized during the course of a year, these admissions remain a window of opportunity to help tobacco users quit. A recent Cochrane review of smoking cessation programs in hospitalized patients found that high-intensity behavioral interventions including at least one month of follow-up contact are effective.[1] Several studies within the VA have demonstrated the effectiveness of this approach to helping smokers quit. Simon et al.[2] randomly assigned 324 patients undergoing non-cardiac surgery at the San Francisco VA Medical Center to either an intervention or control group. Intervention patients watched a smoking cessation videotape and received face-to-face in-hospital counseling, self-help literature, nicotine replacement therapy, and three months of telephone follow-up. The control group received self-help materials and ten minutes of counseling. At one-year follow-up, 27 percent of the intervention group were abstinent as compared to 13 percent of the control group (relative risk 2.1, 95 percent confidence interval 1.2-3.5).

In a separate study at the San Francisco VA Medical Center, Simon et al.[3] enrolled 223 smokers in a hospital-based smoking cessation randomized trial comparing intensive counseling and telephone follow-up with minimal counseling. All patients received transdermal nicotine for two months. At one-year follow-up, the self-reported quit rate was 33 percent in the intervention group vs. 20 percent in the control group (relative risk 1.7, 95 percent confidence interval 1.1-2.7).

A third study tested an alternative approach, that of hospitalizing smokers specifically to help them quit. In an uncontrolled study at the Durham VA Medical Center, Green et al.[4] tested the efficacy of a four-day residential program in 23 smokers who had relapsed after attending the outpatient smoking cessation program. At six-month follow-up, 26 percent of smokers were abstinent (by seven-day point prevalence), which the authors point out is comparable to the success rate seen with other smoking cessation programs.

The programs tested thus far have been rather intensive (on the level of outpatient smoking cessation programs). Future studies should examine the effectiveness of less intensive treatment approaches, as well as ways to integrate inpatient treatment programs with existing resources, such as quitlines.

References

1. Rigotti NA, Munafo MR, Murphy MF, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2003;1:CD001837.
2. Simon JA, Solkowitz SN, Carmody TP, Browner WS. Smoking cessation after surgery. A randomized trial. Arch Intern Med. 1997;157:1371-6.
3. Simon JA, Carmody TP, Hudes ES, Snyder E, Murray J. Intensive smoking cessation counseling versus minimal counseling among hospitalized smokers treated with transdermal nicotine replacement: a randomized trial. Am J Med. 2003;114:555-62.
4. Green A, Yancy WS, Braxton L, Westman EC. Residential smoking therapy. J Gen Intern Med. 2003;18:275-80.

Source: Best Practices in Tobacco Control: Identifying Effective Strategies for Improving Quality within the Veterans Health Administration by Scott E. Sherman, MD, MPH. and Melissa M. Farmer, PhD; in VA in the Vanguard: Building on Success in Smoking Cessation, Conference Proceedings, September 21, 2004

The Public Health Strategic Health Care Group is a part of the Office of Public Health and Environmental Hazards

Best Practices in Tobacco Control within the VA

Hospital-based Tobacco Use Cessation Programs