Nahhas Georges J, Wilson Dianne, Talbot Vince, Cartmell Kathleen B, Warren Graham W, Toll Benjamin A, Carpenter Matthew J, Cummings K Michael
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
TelASK Technologies Inc., Ottawa, Canada.
Nicotine Tob Res. 2017 Aug 1;19(8):937-943. doi: 10.1093/ntr/ntw312.
To assess the feasibility and outcomes of implementing a hospital-based "opt-out" tobacco-cessation service.
In 2014, the Medical University of South Carolina adopted a policy that all hospitalized patients who self-report using tobacco be referred to tobacco-cessation service. This is a descriptive study of a real-world effort to implement guidelines for a hospital-based cessation service consistent with Joint Commission's standards. Between February 2014 and May 2015, 42 061 adults were admitted to the Medical University of South Carolina Hospital. Eligible current cigarette smokers were referred to the tobacco-cessation service, which consisted of a bedside consult and phone follow-up 3, 14, and 30 days after hospital discharge using interactive-voice-response. The primary study outcomes evaluated the proportions of smokers reached by the bedside counselor and/or phone follow-up, smokers who opted out, and smokers who self-reported not smoking when last contacted by phone.
Records identified 8423 smokers, of whom 69.4% (n = 5843) were referred into the service. One full-time bedside counselor was able to speak with 1918 (32.8%) patients, of whom 96 (5%) denied currently smoking and 287 (14.9%) refused counselling. Reach at follow-up was achieved for 703 (55%) smokers who received bedside counselling and 1613 (49%) who did not, yielding an overall follow-up reach rate of 60%. Of those reached by phone, 36.4% reported not smoking (51% vs. 27% for those who did and did not receive bedside counselling, respectively). Intent-to-treat abstinence rate was 13.5% according to the last known smoking status.
Findings from this study suggest that an inpatient smoking-cessation service with an "opt-out" approach can positively impact short-term cessation outcomes.
(1) The findings demonstrate the feasibility of implementing an automated large-scale opt-out tobacco-cessation service for hospitalized patients that is consistent with the Joint Commission recommended standards for treating tobacco dependence. (2) Receiving a bedside tobacco-cessation consult while hospitalized increased the use of stop smoking medications and abstinence from smoking after discharge from the hospital. (3) Even in those patients who did not receive a bedside consult, 5% accepted a referral to the South Carolina Tobacco Quitline to get help to stop smoking.
评估实施基于医院的“选择退出”戒烟服务的可行性和效果。
2014年，南卡罗来纳医科大学采用一项政策，即所有自我报告使用烟草的住院患者都被转介至戒烟服务。这是一项关于为实施符合联合委员会标准的基于医院的戒烟服务指南的实际努力的描述性研究。在2014年2月至2015年5月期间，42061名成年人入住南卡罗来纳医科大学医院。符合条件的当前吸烟者被转介至戒烟服务，该服务包括床边咨询以及出院后3天、14天和30天使用交互式语音应答的电话随访。主要研究结果评估了床边咨询师和/或电话随访联系到的吸烟者比例、选择退出的吸烟者以及最后一次电话联系时自我报告已戒烟的吸烟者。
记录识别出8423名吸烟者，其中69.4%（n = 5843）被转介至该服务。一名全职床边咨询师能够与1918名（32.8%）患者交谈，其中96名（5%）否认当前吸烟，287名（14.9%）拒绝咨询。接受床边咨询的703名（55%）吸烟者和未接受床边咨询的1613名（49%）吸烟者实现了随访联系，总体随访联系率为60%。在通过电话联系到的人中，36.4%报告已戒烟（接受和未接受床边咨询的人分别为51%和27%）。根据最后已知的吸烟状态，意向性戒烟率为13.5%。
本研究结果表明，采用“选择退出”方法的住院戒烟服务可对短期戒烟效果产生积极影响。
（1）研究结果证明了为住院患者实施符合联合委员会推荐的烟草依赖治疗标准的自动化大规模“选择退出”戒烟服务的可行性。（2）住院期间接受床边戒烟咨询增加了出院后戒烟药物的使用和戒烟率。（3）即使在那些未接受床边咨询的患者中，5%接受了转介至南卡罗来纳戒烟热线以获得戒烟帮助。
