Learning Objectives: describe key components of an empirically-validated hospital-based smoking cessation program, as well as how those components can be provided in diverse hospital settings.
Abstract: Smoking cessation interventions for hospitalized patients are both clinically important and cost-effective, but they are not yet a standard aspect of care. Resources for smoking cessation counseling in hospitals are scarce, despite practice guidelines that call for these services to be offered. Staying Free is a well-validated multi-component smoking cessation intervention for inpatients, which has been disseminated to six San Francisco Bay-area hospitals over the last two years. Hospitals involved include Veterans Administration, county, managed care, and community facilities. Each has adapted the original nurse-case-managed model of implementation in order to capitalize on existing staff. These models, including systems for identifying smokers and for providing educational, counseling, pharmacological, and follow-up components, will be presented. Staff involved range from trained volunteers to physicians. Initial data (N=175) suggest that the program results in approximately 27.4% (22.4% to 33.3%) cessation rates at six-month follow-up across hospital settings, with patients lost to follow-up counted as smokers. These results are comparable to controlled trials. In order to provide the program, hospitals need an administrative commitment to providing smoking cessation services, funding for a part-time coordinator of the program, and an advisory board dedicated to developing a workable model of implementation. A key challenge to implementation is the current climate of limited resources in hospitals, including staffing shortages that make it difficult to meet acute care demands. National systems such as NCQA, JCAHO, and the AMA can set policies that encourage hospitals to prioritize the identification and treatment of smokers.
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