Increasing hospital-wide delivery of smoking cessation care for nicotine-dependent in-patients: a multi-strategic intervention trial (original) (raw)
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Evidence Check: Smoking cessation care in hospitals
2016
This Sax Institute Evidence Check review examines models of managing nicotine dependence in health facilities under a smoke-free healthcare policy directive. The research evidence suggests that smoking cessation can be increased via a number of interventions including: smoking status assessment; provision of advice/counselling; nicotine replacement therapy; and referral for specialist follow-up. A number of clinical practice strategies, such as training, electronic reminders and leadership were found to be effective at increasing clinician provision of smoking cessation care. A review of best practice documents and initiatives implemented in Australasian jurisdictions identified a number of policies, frameworks, tools and services intended to support delivery of smoking cessation care.
Increasing smoking cessation care provision in hospitals: A meta-analysis of intervention effect
Nicotine & Tobacco Research, 2009
The review found that interventions could be moderately effective in increasing routine provision of assistance and counselling to stop smoking for hospital patients. Potential for missed studies and the heterogeneous evidence mean the authors' conclusions should be interpreted with caution. Authors' objectives To evaluate the effectiveness of controlled intervention studies in increasing the routine provision of smoking cessation in hospitals. Searching MEDLINE, EMBASE, CINAHL and PsycINFO were searched from January 1994 to June 2007 for publications in English; search terms were reported. The bibliography of each retrieved article was handsearched. Only articles with abstracts that could be checked were searched. Dissertations were excluded. Research: The authors stated that future research should endeavour to use stronger study designs to examine hospitalwide provision of a broader range of smoking cessation care practices, particularly nicotine replacement therapy and follow-up or referral to further quitting assistance. Such research would be strengthened by improved reporting of
Preventive medicine
A systematic review and meta-analysis was conducted to evaluate evidence-based strategies for increasing the delivery of smoking cessation treatments in primary care clinics. The review included studies published before January 1, 2009. The pooled odds-ratio (OR) was calculated for intervention group versus control group for practitioner performance for "5As" (Ask, Advise, Assess, Assist and Arrange) delivery and smoking abstinence. Multi-component interventions were defined as interventions which combined two or more intervention strategies. Thirty-seven trials met eligibility criteria. Evidence from multiple large-scale trials was found to support the efficacy of multi-component interventions in increasing "5As" delivery. The pooled OR for multi-component interventions compared to control was 1.79 [95% CI 1.6-2.1] for "ask", 1.6 [95% CI 1.4-1.8] for "advice", 9.3 [95% CI 6.8-12.8] for "assist" (quit date) and 3.5 [95% CI 2.8-4.2] f...
Implementation Science, 2016
Background: Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods: This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre-and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended). Results: Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre-to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0. 001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76. 0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive ("user friendly," "streamlined," or "saves time"), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended. Conclusions: Given that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation. Trial registration: ClinicalTrials.gov, NCT01309217
Australian and New Zealand Journal of Public Health, 2005
Objective: Does the provision of a nursebased intervention lead to smoking cessation in hospital patients? Methods: At tertiary teaching hospital in Newcastle, Australia, 4,n9 eligible (aged 18-80, admitted for at least 24 hours, and able to provide informed consent) and consenting (73.4%) in-patients were recruited into a larger cross-sectional survey. 1,422 (29.7%) smokers (in the last 12 months) were randomly assigned to control (n=711) or intervention group (n=711). The brief nurse-delivered intervention incorporated: tailored information, assessment of withdrawal, offer of nicotine replacement therapy,
Journal of Smoking Cessation, 2018
Background: Although the hospital inpatient setting arguably provides an ideal opportunity to engage patients in smoking cessation interventions, this is done infrequently. We therefore aimed to systematically review the perceived barriers to the implementation of smoking cessation interventions in the hospital inpatient setting.Methods: A systematic literature search was conducted specific to hospital-based healthcare workers’ perceived barriers to implementing smoking cessation interventions. Reported barriers were categorised using the capability, opportunity and motivation (COM-B) framework.Results: Eighteen studies were selected for inclusion, which consisted of cross-sectional surveys and interviews. The most commonly identified barrier in capability was lack of knowledge (56% of studies); in Opportunity, it was a lack of time (78%); while in Motivation, a lack of perceived patient motivation to quit smoking (44%). Seventeen other barriers were also endorsed, but less frequent...
Offering Population-Based Tobacco Treatment in a Healthcare Setting
American Journal of Preventive Medicine, 2011
Background-The healthcare system is a key channel for delivering treatment to tobacco users. Brief clinic-based interventions are effective but not reliably offered. Population management strategies might improve tobacco treatment delivery in a healthcare system.
IPCRG Consensus statement: Tackling the smoking epidemic - practical guidance for primary care
Primary Care Respiratory Journal, 2008
Tobacco use will become the world's foremost cause of premature death and disability within 20 years unless current trends are reversed. Many opportunities to reduce this epidemic are missed in primary care. This Discussion paper from the International Primary Care Respiratory Group (IPCRG) -which reflects the IPCRG's understanding of primary care practitioners' needs -summarises a new approach based on strong evidence for effective interventions.