Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA.
Community Behavioral Health, Philadelphia, Pennsylvania, USA.
Subst Abus. 2020;41(2):252-258. doi: 10.1080/08897077.2019.1635556. Epub 2019 Jul 11.
Cardiovascular and respiratory diseases, predominantly due to tobacco use, are the leading causes of death among individuals with serious and persistent mental illness. However, many psychiatric health facilities do not routinely treat tobacco use disorder. The purpose of the current study was to examine the impact of implementing a tobacco-free policy in inpatient psychiatric health facilities in a large, urban setting on behavioral problems, treatment access, and tobacco treatment. Data on seclusion and restraint incidents, voluntary commitment at admission for each hospitalization episode, and nicotine replacement therapy (NRT) prescriptions were collected through secondary analysis of Medicaid administrative records from baseline in January 2015 ( = 8983) to follow-up in December 2016 ( = 9685) at 14 inpatient psychiatric health facilities. There were no significant changes from baseline to follow-up in odds of seclusion and restraint incidents or voluntary admission status. There was a significant increase in the odds of NRT prescriptions at both 30 and 180 days post discharge (odds ratio [OR] range = 1.58-2.09, < .01). In a large, urban setting among Medicaid enrollees, implementation of a tobacco-free policy in inpatient psychiatric health facilities had no negative impact on behavioral problems or treatment access and improved access to NRT, although overall NRT use remained low. This study challenges perceptions among some providers that addressing tobacco use disorder will negatively impact treatment outcomes in individuals with serious mental illness. These findings support tobacco-free policies in psychiatric health facilities and the role of psychiatric health providers in treating tobacco use in this population, which is at high risk for tobacco-related mortality.
心血管和呼吸系统疾病主要是由于烟草使用，是严重和持续的精神疾病患者的主要死亡原因。然而，许多精神卫生机构并没有常规治疗烟草使用障碍。本研究的目的是在一个大型城市环境中，检查在住院精神病卫生机构中实施无烟政策对行为问题、治疗机会和烟草治疗的影响。 通过对从 2015 年 1 月（ = 8983）到 2016 年 12 月（ = 9685）的 Medicaid 管理记录的二次分析，收集了关于隔离和约束事件、每次住院入院时的自愿承诺以及尼古丁替代疗法（NRT）处方的数据。 在 14 家住院精神病卫生机构中。 从基线到随访，隔离和约束事件或自愿入院状态的几率没有显著变化。在出院后 30 天和 180 天，NRT 处方的几率显著增加（比值比[OR]范围 = 1.58-2.09， < .01）。 在大型城市 Medicaid 参保人群中，在住院精神病卫生机构中实施无烟政策对行为问题或治疗机会没有负面影响，并改善了 NRT 的获得，尽管总体 NRT 使用仍然较低。这项研究挑战了一些提供者的看法，即解决烟草使用障碍将对严重精神疾病患者的治疗结果产生负面影响。这些发现支持精神病卫生机构的无烟政策以及精神卫生提供者在该人群中治疗烟草使用的作用，该人群患与烟草相关的死亡率的风险很高。
