Comparative Effectiveness of Postdischarge Smoking Cessation Interventions for Hospital Patients: Th
Friday, July 15, 2022
Posted by: Natalia Gromov
Rigotti NA, Chang Y, Davis
EM, et al.
Comparative Effectiveness
of Postdischarge Smoking Cessation Interventions for Hospital Patients: The
Helping HAND 4 Randomized Clinical Trial.
[published online ahead of print, 2022 Jun 27]. JAMA Intern Med.
2022;10.1001/jamainternmed.2022.2300. doi:10.1001/jamainternmed.2022.2300
Importance. Smoking
cessation interventions for hospitalized patients must continue after discharge
to improve long-term tobacco abstinence. How health systems can best deliver
postdischarge tobacco treatment is uncertain.
Objective. To
determine if health system-based tobacco cessation treatment after hospital
discharge produces more long-term tobacco abstinence than referral to a
community-based quitline.
Design, setting, and
participants. This randomized clinical trial was conducted
September 2018 to November 2020 in 3 hospitals in Massachusetts, Pennsylvania,
and Tennessee. Cigarette smokers admitted to a study hospital who received
brief in-hospital tobacco treatment and wanted to quit smoking were recruited
for participation and randomized for postdischarge treatment to health
system-based Transitional Tobacco Care Management (TTCM) or electronic referral
to a community-based quitline (QL). Both multicomponent interventions offered
smoking cessation counseling and nicotine replacement therapy (NRT) for up to 3
months. Data were analyzed from February 1, 2021, to April 25, 2022.
Interventions. TTCM
provided 8 weeks of NRT at discharge and 7 automated calls with a
hospital-based counselor call-back option. The QL intervention sent referrals
from the hospital electronic health record to the state quitline, which offered
5 counseling calls and an NRT sample.
Main outcomes and
measures. The main outcome was biochemically verified past
7-day tobacco abstinence at 6 months. Self-reported point-prevalence and
continuous tobacco abstinence and tobacco treatment utilization were assessed
1, 3, and 6 months after discharge.
Results. A
total of 1409 participants (mean [SD] age, 51.7 [12.6] years; 784 [55.6%]
women; mean [SD] 16.4 [10.6] cigarettes/day) were recruited, including 706
randomized to TTCM and 703 randomized to QL. Participants were comparable at
baseline, including 216 Black participants (15.3%), 82 Hispanic participants
(5.8%), and 1089 White participants (77.3%). At 1 and 3 months after discharge,
more TTCM participants than QL participants used cessation counseling (1 month:
245 participants [34.7%] vs 154 participants [21.9%]; 3 months: 248
participants [35.1%] vs 123 participants [17.5%]; P < .001) and
pharmacotherapy (1 month: 455 participants [64.4%] vs 324 participants [46.1%];
3 months: 367 participants [52.0%] vs 264 participants [37.6%]; P < .001).
More TTCM than QL participants reported continuous abstinence for 3 months (RR,
1.30; 95% CI, 1.06-1.58) and point-prevalence abstinence at 1 month (RR, 1.22;
95% CI, 1.08-1.35) and 3 months (RR, 1.23; 95% CI, 1.09-1.37) but not at 6
months (RR, 1.14; 95% CI, 0.99-1.29). The primary outcome, biochemically
verified point-prevalence abstinence at 6 months, was not statistically
significantly different between groups (19.9% vs 16.9%; RR, 1.18; 95% CI,
0.92-1.50).
Conclusions and
relevance. In this randomized clinical trial,
biochemically verified tobacco abstinence rates were not significantly
different between groups at the 6-month follow-up. However, the health
system-based model was superior to the community-based quitline model
throughout the 3 months of active treatment. A longer duration of postdischarge
treatment may sustain the superiority of the health system-based model.
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