Smoking is a leading cause of preventable death worldwide, and the health consequences of smoking are well-documented. Despite this, many individuals continue to smoke, and frequently they are admitted to hospital due to health problems.
A US study showed that 20.5% of hospitalized patients were smokers. Smoking was most common among men, young age groups (18–64 years), and individuals with primary or less than primary education. Of the smokers, 97.2% were daily consumers of whom 44.9% had medium nicotine dependence. Of all smokers, three-quarters wished to quit, and one-quarter admitted to consuming tobacco during hospitalization. (1)
Hospitalization can be a stressful and transformative experience, and it can catalyze change and presents a unique opportunity for healthcare professionals to encourage smoking cessation, yet it is often a missed opportunity.
Hospitalized patients are more receptive to smoking cessation messages due to their heightened awareness of their health status. Additionally, they may be more likely to quit smoking during their hospital stay because they are in a controlled environment and have limited access to cigarettes.
Research has shown that addressing smoking cessation during hospitalization can have a significant impact on patient outcomes. Patients who receive smoking cessation counseling during hospitalization are more likely to quit smoking compared to those who do not receive counseling. Additionally, patients who quit smoking have improved health outcomes and a reduced risk of readmission.
However, healthcare professionals often fail to take advantage of this opportunity. Addressing smokers during hospitalization is a missed opportunity to encourage smoking cessation and improve patient outcomes.
Studies have found that healthcare providers often do not intervene in smoking cessation or fail to address that adequately during hospitalization or to provide ongoing support.
A 2012 Cochrane meta-analysis found that tobacco use disorder treatment initiated during hospitalization leads to sustained abstinence only if medication or counseling (or both) treatment continue at least 30 days after hospital discharge. (2)
Many of the studies in this meta-analysis provided ongoing care in the form of multiple visits during the hospitalization and post-discharge contacts via telephone or in-person counseling.
In most cases, the intervention was delivered by a research nurse or trained tobacco dependence counselor. In most studies, pharmacotherapy in the form of nicotine replacement medicines, bupropion, or varenicline was provided to the patient. (3)
This failure to address smoking during hospitalization is a missed opportunity for patients, healthcare providers and healthcare professionals.
To address this missed opportunity, healthcare professionals should prioritize smoking cessation counseling during hospitalization. This can be achieved by implementing smoking cessation protocols and training healthcare professionals on smoking cessation counseling.
There are some models of in-hospital smoking cessation interventions that can be used as a guide. I´m sharing one: The Ottawa Model.
The Ottawa Model for Smoking Cessation (OMSC) (4) is a systematic, comprehensive approach to clinical tobacco dependence treatment. It is designed to assist health professionals to transform clinical practice through knowledge translation, implementation support, and quality evaluation.
With the application of a systematic, evidence-based program, there was an increase in the rates of delivery of smoking cessation best practices by healthcare providers. As a result, more patients made further assisted quit attempts resulting in long-lasting quit rates.
In conclusion, addressing smoking cessation during hospitalization is a missed opportunity to improve patients´ health outcomes. Healthcare professionals should prioritize smoking cessation counseling during hospitalization and provide patients with the support they need to quit smoking.
References
(1) Martínez C, Fu M, Castellano Y, Riccobene A, Fernández P, Cabrera S, Gavilan E, Feliu A, Puig-Llobet M, Fuster P, Martínez-Sánchez JM, Montes J, Estrada JM, Moreno C, Falcó-Pegueroles A, Galimany J, Brando C, Suñer-Soler R, Capsada A, Fernández E; y Grupo de Coordinadores de la Red Catalana de Hospitales sin Humo (XCHsF). Smoking among hospitalized patients: A multi-hospital cross-sectional study of a widely neglected problem. Tob Induc Dis. 2018 Jul 30;16:34. doi: 10.18332/tid/92927. PMID: 31516433; PMCID: PMC6659490.
(2) Rigotti NA, Clair C, Munafò MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2012;(5):CD001837. https://doi.org/10.1002/14651858.CD001837.pub3.
(3) Bernstein, S.L., Weiss, J., DeWitt, M. et al. A randomized trial of decision support for tobacco dependence treatment in an inpatient electronic medical record: clinical results.Implementation Sci 14, 8 (2019). https://doi.org/10.1186/s13012-019-0856-8
(4) https://ottawamodel.ottawaheart.ca/about-omsc
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master’s in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Bianco’s research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. He is a member of the HIFA working group on substance use disorders. https://www.hifa.org/support/members/eduardo Email: ebianco AT nextgenu.org
