Sustained Care Intervention and Postdischarge Smoking Cessation Among Hospitalized Adults A Randomized Clinical Trial
Sustained Care Intervention and Postdischarge Smoking Cessation Among Hospitalized Adults A Randomized Clinical Trial
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DOI：
10.1001/jama.2014.9237
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发表时间：
2014-08-20
影响因子：
120.7
通讯作者：
Singer, Daniel E.
中科院分区：
文献类型：
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作者：
Rigotti, Nancy A.;Regan, Susan;Singer, Daniel E.
重要性医疗保健系统需要有效的模式来管理慢性疾病，如烟草依赖在护理过渡。住院治疗为吸烟者提供了戒烟的机会，但研究表明，只有在出院后继续治疗时，医院提供的干预措施才有效。一项随机临床试验比较了持续护理在397名住院的每日吸烟者中进行标准治疗的出院后戒烟干预（平均年龄53岁; 48%为男性; 81%为非西班牙裔白人），出院后希望戒烟并在医院接受烟草依赖干预; 92%的合格患者和44%的筛选患者入组。该研究于2010年8月至2012年11月在马萨诸塞州综合医院进行，干预持续护理参与者接受自动交互式语音应答电话，并选择免费戒烟药物（美国食品和药物管理局批准的任何类型）长达90天。自动电话促进戒烟，提供药物管理，并对吸烟者进行额外的咨询。标准护理参与者接受出院后药物治疗和咨询的建议。主要结果和措施的主要结果是生化证实过去7天的戒烟在6个月的随访出院后;次要结果包括自我报告的戒烟情况。结果随机分配到持续护理组的吸烟者（n = 198）在每次随访时使用更多的咨询和更多的药物治疗。比分配到标准护理组的患者（n = 199）更高的评估。6个月时经生化验证的7天戒烟率，持续护理组（26%）高于标准护理组（15%）（相对风险[RR]，1.71 [95%CI，1.14-2.56]，P = 0.009;需要治疗的人数，9.4 [95%CI，5.4-35.5]）。对缺失的结果使用多重插补，戒烟7天的RR为1.55（95%CI，1.03-2.21; P = 0.04）。持续护理也导致出院后6个月内自我报告的持续戒烟率较高（27% vs 16%标准治疗; RR，1.70 [95%CI，1.15-2.51]; P = .007）。结论和相关性在住院的成年吸烟者谁想要戒烟，出院后干预提供自动电话呼叫和免费药物治疗，与标准建议相比，在6个月后使用咨询和药物治疗，放电这些发现，如果复制，建议一种方法，以帮助实现住院后持续戒烟。
IMPORTANCE Health care systems need effective models to manage chronic diseases like tobacco dependence across transitions in care. Hospitalizations provide opportunities for smokers to quit, but research suggests that hospital-delivered interventions are effective only if treatment continues after discharge.OBJECTIVE To determine whether an intervention to sustain tobacco treatment after hospital discharge increases smoking cessation rates compared with standard care.DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial compared sustained care (a postdischarge tobacco cessation intervention) with standard care among 397 hospitalized daily smokers (mean age, 53 years; 48% were males; 81% were non-Hispanic whites) who wanted to quit smoking after discharge and received a tobacco dependence intervention in the hospital; 92% of eligible patients and 44% of screened patients enrolled. The study was conducted from August 2010 through November 2012 at Massachusetts General Hospital.INTERVENTIONS Sustained care participants received automated interactive voice response telephone calls and their choice of free smoking cessation medication (any type approved by the US Food and Drug Administration) for up to 90 days. The automated telephone calls promoted cessation, provided medication management, and triaged smokers for additional counseling. Standard care participants received recommendations for postdischarge pharmacotherapy and counseling.MAIN OUTCOMES AND MEASURES The primary outcome was biochemically confirmed past 7-day tobacco abstinence at 6-month follow-up after discharge from the hospital; secondary outcomes included self-reported tobacco abstinence.RESULTS Smokers randomly assigned to sustained care (n = 198) used more counseling and more pharmacotherapy at each follow-up assessment than those assigned to standard care (n = 199). Biochemically validated 7-day tobacco abstinence at 6 months was higher with sustained care (26%) than with standard care (15%) (relative risk [RR], 1.71 [95% CI, 1.14-2.56], P = .009; number needed to treat, 9.4 [95% CI, 5.4-35.5]). Using multiple imputation for missing outcomes, the RR for 7-day tobacco abstinence was 1.55 (95% CI, 1.03-2.21; P = .04). Sustained care also resulted in higher self-reported continuous abstinence rates for 6 months after discharge (27% vs 16% for standard care; RR, 1.70 [95% CI, 1.15-2.51]; P = .007).CONCLUSIONS AND RELEVANCE Among hospitalized adult smokers who wanted to quit smoking, a postdischarge intervention providing automated telephone calls and free medication resulted in higher rates of smoking cessation at 6 months compared with a standard recommendation to use counseling and medication after discharge. These findings, if replicated, suggest an approach to help achieve sustained smoking cessation after a hospital stay.