Critical steps in the path to using cessation pharmacotherapy following hospital-initiated tobacco treatment

Edward P Liebmann, Taneisha S Scheuermann, Babalola Faseru, Kimber P Richter, Edward P Liebmann, Taneisha S Scheuermann, Babalola Faseru, Kimber P Richter

Abstract

Background: Hospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates. Use of smoking cessation medications following discharge may further increase quit rates. This study aims to identify individual, smoking-related and hospitalization-related predictors of engagement in three different steps in the smoking cessation pharmacotherapy utilization process: 1) receiving medications as inpatient, 2) being discharged with a prescription and 3) using medications at 1-month post-hospitalization, while accounting for associations between these steps.

Methods: Study data come from a clinical trial (N = 1054) of hospitalized smokers interested in quitting who were randomized to recieve referral to a quitline via either warm handoff or fax. Variables were from the electronic health record, the state tobacco quitline, and participant self-report. Relationships among the predictors and the steps in cessation medication utilization were assessed using bivariate analyses and multivariable path analysis.

Results: Twenty-eight percent of patients reported using medication at 1-month post-discharge. Receipt of smoking cessation medications while hospitalized (OR = 2.09, 95%CI [1.39, 3.15], p < .001) and discharge with a script (OR = 4.88, 95%CI [3.34, 7.13], p < .001) were independently associated with medication use at 1-month post-hospitalization. The path analysis also revealed that the likelihood of being discharged with a script was strongly influenced by receipt of medication as an inpatient (OR = 6.61, 95%CI [4.66, 9.38], p < .001). A number of other treatment- and individual-level factors were associated with medication use in the hospital, receipt of a script, and use post-discharge.

Conclusions: To encourage post-discharge smoking cessation medication use, concerted effort should be made to engage smokers in tobacco treatment while in hospital. The individual and hospital-level factors associated with each step in the medication utilization process provide good potential targets for future implementation research to optimize treatment delivery and outcomes.

Trial registration: Number: NCT01305928 . Date registered: February 24, 2011.

Keywords: Medication reconciliation; Patient discharge; Smoking cessation; Tobacco use cessation devices.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was obtained from the University of Kansas Medical Center Institutional Review Board. Informed consent for study participation was obtained in writing from all participants prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no completing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Schematic diagram for study path analysis The bulleted variables correspond to the independent variables in the model and the three medication-related variables correspond to the dependent variables. All arrows denote regression. In addition, each bulleted variable is a predictor of its respective outcome variable. Note. ED = Emergency department, HSI = Heaviness of Smoking Index

References

    1. Benowitz N. L., Schultz K. E., Haller C. A., Wu A. H. B., Dains K. M., Jacob P. Prevalence of Smoking Assessed Biochemically in an Urban Public Hospital: A Rationale for Routine Cotinine Screening. American Journal of Epidemiology. 2009;170(7):885–891. doi: 10.1093/aje/kwp215.
    1. Rigotti NA, Clair C, Munafò MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2012;5:Cd001837.
    1. Cummins SE, Gamst AC, Brandstein K, Seymann GB, Klonoff-Cohen H, Kirby CA, et al. Helping hospitalized smokers: a factorial RCT of nicotine patches and counseling. Am J Prev Med. 2016;51(4):578–586. doi: 10.1016/j.amepre.2016.06.021.
    1. Freund M, Campbell E, Paul C, Sakrouge R, Wiggers J. Smoking care provision in smoke-free hospitals in Australia. Prev Med. 2005;41(1):151–158. doi: 10.1016/j.ypmed.2004.09.044.
    1. Regan S, Reyen M, Richards AE, Lockhart AC, Liebman AK, Rigotti NA. Nicotine replacement therapy use at home after use during a hospitalization. Nicotine Tob Res. 2012;14(7):885–889. doi: 10.1093/ntr/ntr244.
    1. Chui Chang Yue, Thomas Dennis, Taylor Simone, Bonevski Billie, Abramson Michael J., Paul Eldho, Poole Susan G., Weeks Gregory R., Dooley Michael J., George Johnson. Factors associated with nicotine replacement therapy use among hospitalised smokers. Drug and Alcohol Review. 2018;37(4):514–519. doi: 10.1111/dar.12661.
    1. Rigotti NA, Arnsten JH, McKool KM, Wood-Reid KM, Singer DE, Pasternak RC. The use of nicotine-replacement therapy by hospitalized smokers. Am J Prev Med. 1999;17(4):255–259. doi: 10.1016/S0749-3797(99)00095-1.
    1. Emmons KM, Goldstein MG, Roberts M, Cargill B, Sherman CB, Millman R, et al. The use of nicotine replacement therapy during hospitalization. Ann Behav Med. 2000;22(4):325–329. doi: 10.1007/BF02895669.
    1. Holbrook A, Bowen JM, Patel H, O'Brien C, You JJ, Tahavori R, et al. Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement. BMJ Open. 2016;6(12):e013663. doi: 10.1136/bmjopen-2016-013663.
    1. Richter KP, Faseru B, Shireman TI, Mussulman LM, Nazir N, Bush T, et al. Warm handoff versus fax referral for linking hospitalized smokers to Quitlines. Am J Prev Med. 2016;51(4):587–596. doi: 10.1016/j.amepre.2016.04.006.
    1. Richter KP, Faseru B, Mussulman LM, Ellerbeck EF, Shireman TI, Hunt JJ, et al. Using “warm handoffs” to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Trials. 2012;13(1):127. doi: 10.1186/1745-6215-13-127.
    1. Lando H, Hennrikus D, McCarty M, Vessey J. Predictors of quitting in hospitalized smokers. Nicotine Tob Res. 2003;5(2):215–222. doi: 10.1080/0955300031000083436.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J. Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict. 1989;84(7):791–799. doi: 10.1111/j.1360-0443.1989.tb03059.x.
    1. Wolfle L. The introduction of path analysis to the social sciences, and some emergent themes: an annotated bibliography. Struct Equ Model Multidiscip J. 2003;10(1):1–34. doi: 10.1207/S15328007SEM1001_1.
    1. Muthen L, Muthen B. Mplus User's Guide. Los Angeles: Muthen & Muthen; 1998.
    1. Asparouhov T, Muthen B. Multiple imputation with Mplus. 2010.
    1. Enders C. Applied missing data analysis. New York: Guilford; 2010.
    1. Melzer AC, Feemster LC, Collins MP, Au DH. Predictors of pharmacotherapy for tobacco use among veterans admitted for COPD: the role of disparities and tobacco control processes. J Gen Intern Med. 2016;31(6):623–629. doi: 10.1007/s11606-016-3623-4.
    1. Shiffman S, Di Marino ME, Sweeney CT. Characteristics of selectors of nicotine replacement therapy. Tob Control. 2005;14(5):346–355. doi: 10.1136/tc.2004.009183.
    1. Lowenstein SR, Tomlinson D, Koziol-McLain J, Prochazka A. Smoking habits of emergency department patients: an opportunity for disease prevention. Acad Emerg Med. 1995;2(3):165–171. doi: 10.1111/j.1553-2712.1995.tb03189.x.
    1. Bernstein SL, Bijur P, Cooperman N, Jearld S, Arnsten JH, Moadel A, et al. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Acad Emerg Med. 2011;18(6):575–583. doi: 10.1111/j.1553-2712.2011.01097.x.
    1. Faseru B, Yeh HW, Ellerbeck EE, Befort C, Richter KP. Prevalence and predictors of tobacco treatment in an academic medical center. Jt Comm J Qual Patient Saf. 2009;35(11):551–557. doi: 10.1016/S1553-7250(09)35075-8.

Source: PubMed

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