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A Post-Discharge Smoking-Cessation Intervention for Hospital Patients: Helping Hand 2 Randomized Clinical Trial.
Am J Prev Med. 2016 10; 51(4):597-608.AJ

Abstract

INTRODUCTION

Hospitalization provides an opportunity for smokers to quit, but tobacco-cessation interventions started in hospital must continue after discharge to be effective. This study aimed to improve the scalability of a proven effective post-discharge intervention by incorporating referral to a telephone quitline, a nationally available cessation resource.

STUDY DESIGN

A three-site RCT compared Sustained Care, a post-discharge tobacco-cessation intervention, with Standard Care among hospitalized adult smokers who wanted to quit smoking and received in-hospital tobacco-cessation counseling.

SETTING/PARTICIPANTS

A total of 1,357 daily smokers admitted to three hospitals were enrolled from December 2012 to July 2014.

INTERVENTION

Sustained Care started at discharge and included automated interactive voice response telephone calls and the patient's choice of cessation medication for 3 months. Each automated call advised cessation, supported medication adherence, and triaged smokers seeking additional counseling or medication support directly to a telephone quitline. Standard Care provided only medication and counseling recommendations at discharge.

MAIN OUTCOME MEASURES

Biochemically confirmed past 7-day tobacco abstinence 6 months after discharge (primary outcome) and self-reported tobacco abstinence and tobacco-cessation treatment use at 1, 3, and 6 months and overall (0-6 months). Analyses were done in 2015-2016.

RESULTS

Smokers offered Sustained Care (n=680), versus those offered Standard Care (n=677), did not have greater biochemically confirmed abstinence at 6 months (17% vs 16%, p=0.58). However, the Sustained Care group reported more tobacco-cessation counseling and medication use at each follow-up and higher rates of self-reported past 7-day tobacco abstinence at 1 month (43% vs 32%, p<0.0001) and 3 months (37% vs 30%, p=0.008). At 6 months, the difference narrowed (31% vs 27%, p=0.09). Overall, the intervention increased self-reported 7-day abstinence over the 6-month follow-up (relative risk, 1.25; 95% CI=1.10, 1.40; p=0.0006).

CONCLUSIONS

A 3-month post-discharge smoking-cessation intervention for hospitalized smokers who wanted to quit did not increase confirmed tobacco abstinence at 6 months but did increase self-reported abstinence during the treatment period (3 months). Real-time linkage of interactive voice response calls to a quitline, done in this trial to increase scalability of a previously proven cessation intervention, demonstrated short-term promise but did not sustain long-term intervention effectiveness.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01714323.

Authors+Show Affiliations

Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts. Electronic address: nrigotti@partners.org.Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.Alere Wellbeing, Inc., Seattle, Washington.Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, Massachusetts.Department of Psychological Science, University of Vermont, Burlington, Vermont.Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston, Massachusetts.Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27647060

Citation

Rigotti, Nancy A., et al. "A Post-Discharge Smoking-Cessation Intervention for Hospital Patients: Helping Hand 2 Randomized Clinical Trial." American Journal of Preventive Medicine, vol. 51, no. 4, 2016, pp. 597-608.
Rigotti NA, Tindle HA, Regan S, et al. A Post-Discharge Smoking-Cessation Intervention for Hospital Patients: Helping Hand 2 Randomized Clinical Trial. Am J Prev Med. 2016;51(4):597-608.
Rigotti, N. A., Tindle, H. A., Regan, S., Levy, D. E., Chang, Y., Carpenter, K. M., Park, E. R., Kelley, J. H., Streck, J. M., Reid, Z. Z., Ylioja, T., Reyen, M., & Singer, D. E. (2016). A Post-Discharge Smoking-Cessation Intervention for Hospital Patients: Helping Hand 2 Randomized Clinical Trial. American Journal of Preventive Medicine, 51(4), 597-608. https://doi.org/10.1016/j.amepre.2016.04.005
Rigotti NA, et al. A Post-Discharge Smoking-Cessation Intervention for Hospital Patients: Helping Hand 2 Randomized Clinical Trial. Am J Prev Med. 2016;51(4):597-608. PubMed PMID: 27647060.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Post-Discharge Smoking-Cessation Intervention for Hospital Patients: Helping Hand 2 Randomized Clinical Trial. AU - Rigotti,Nancy A, AU - Tindle,Hilary A, AU - Regan,Susan, AU - Levy,Douglas E, AU - Chang,Yuchiao, AU - Carpenter,Kelly M, AU - Park,Elyse R, AU - Kelley,Jennifer H K, AU - Streck,Joanna M, AU - Reid,Zachary Z, AU - Ylioja,Thomas, AU - Reyen,Michele, AU - Singer,Daniel E, PY - 2016/01/18/received PY - 2016/03/29/revised PY - 2016/04/03/accepted PY - 2016/9/21/entrez PY - 2016/9/21/pubmed PY - 2017/12/27/medline SP - 597 EP - 608 JF - American journal of preventive medicine JO - Am J Prev Med VL - 51 IS - 4 N2 - INTRODUCTION: Hospitalization provides an opportunity for smokers to quit, but tobacco-cessation interventions started in hospital must continue after discharge to be effective. This study aimed to improve the scalability of a proven effective post-discharge intervention by incorporating referral to a telephone quitline, a nationally available cessation resource. STUDY DESIGN: A three-site RCT compared Sustained Care, a post-discharge tobacco-cessation intervention, with Standard Care among hospitalized adult smokers who wanted to quit smoking and received in-hospital tobacco-cessation counseling. SETTING/PARTICIPANTS: A total of 1,357 daily smokers admitted to three hospitals were enrolled from December 2012 to July 2014. INTERVENTION: Sustained Care started at discharge and included automated interactive voice response telephone calls and the patient's choice of cessation medication for 3 months. Each automated call advised cessation, supported medication adherence, and triaged smokers seeking additional counseling or medication support directly to a telephone quitline. Standard Care provided only medication and counseling recommendations at discharge. MAIN OUTCOME MEASURES: Biochemically confirmed past 7-day tobacco abstinence 6 months after discharge (primary outcome) and self-reported tobacco abstinence and tobacco-cessation treatment use at 1, 3, and 6 months and overall (0-6 months). Analyses were done in 2015-2016. RESULTS: Smokers offered Sustained Care (n=680), versus those offered Standard Care (n=677), did not have greater biochemically confirmed abstinence at 6 months (17% vs 16%, p=0.58). However, the Sustained Care group reported more tobacco-cessation counseling and medication use at each follow-up and higher rates of self-reported past 7-day tobacco abstinence at 1 month (43% vs 32%, p<0.0001) and 3 months (37% vs 30%, p=0.008). At 6 months, the difference narrowed (31% vs 27%, p=0.09). Overall, the intervention increased self-reported 7-day abstinence over the 6-month follow-up (relative risk, 1.25; 95% CI=1.10, 1.40; p=0.0006). CONCLUSIONS: A 3-month post-discharge smoking-cessation intervention for hospitalized smokers who wanted to quit did not increase confirmed tobacco abstinence at 6 months but did increase self-reported abstinence during the treatment period (3 months). Real-time linkage of interactive voice response calls to a quitline, done in this trial to increase scalability of a previously proven cessation intervention, demonstrated short-term promise but did not sustain long-term intervention effectiveness. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01714323. SN - 1873-2607 UR - https://www.unboundmedicine.com/medline/citation/27647060/A_Post_Discharge_Smoking_Cessation_Intervention_for_Hospital_Patients:_Helping_Hand_2_Randomized_Clinical_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(16)30097-6 DB - PRIME DP - Unbound Medicine ER -