Implementing Effective Smoking Cessation Pharmacotherapy for Hospitalized Smokers with Cardiopulmonary Disease

项目总结 烟草使用仍然是美国最主要的死亡原因，造成700多万人死亡 每年住院治疗。住院为干预提供了一个关键的窗口：医院政策禁止 吸烟，患者戒烟的积极性很高，社会指南建议临床医生应该 建议患者并为几乎所有吸烟者开出戒烟药物疗法(SCP)。 然而，只有22%的患者在住院期间曾开过SCP，只有1%的患者在住院期间开过SCP 规定的指南-与SCP一致。这一失败最终导致了70%-80%的复吸率， 其中大多数发生在出院后的几天内--远远早于门诊随访。 如果我们要利用住院治疗提供的机会来最大限度地戒烟 治疗和结果，需要新的策略来克服指南一致的SCP摄取率低的问题 由医生和病人共同完成。为解决这个问题，我们建议调派一间由执业护士主导的医院- 以烟草治疗团队为基础：1)为个人量身定做并符合指南的SCP；2)法律顾问 并激励患者正确使用SCP；以及3)管理基于移动电话的短信系统 保持患者对SCP的积极性和依从性。我们的初步数据表明，这种方法是 可行并为患者、医生和医院管理人员所接受。 在目标1中，我们将在424名受试者中进行一项平行分组实施效果随机试验 患有心肺疾病的吸烟者在一家大型三级医院住院。我们将比较SCP的费率 接受干预的患者和未接受干预的患者之间的使用和戒烟情况。在目标2中， 我们将从医院和支付者的角度衡量干预的经济价值，以更好地 告知医院和保险政策以及可持续性。在目标3中，我们将对以下人员进行定性采访 患者、医生、工作人员和医院管理人员评估可接受性和可持续性 我们的战略。我们假设我们的干预措施将：改善符合指南的SCP使用；增加6- 一个月的戒烟率；患者、临床医生和管理人员可以接受；成本效益高 而且是可持续的。 我们的多学科团队在心肺医学、烟草治疗、 实施科学、用药依从性、定性方法、卫生经济学和短信 技术在这笔赠款结束时，我们的团队将制定一个详细的、循证的实施方案 以医院为基础的烟草治疗小组指南。最终，我们期待从这一过程中获得知识 研究将促进以医院为基础的广泛和有效的烟草治疗，使更多的患者过上生活 远离烟草和心肺疾病。

PROJECT SUMMARY Tobacco use remains the leading cause of death in the United States and contributes to more than 7 million hospitalizations annually. Hospitalization offers a critical window for intervention: hospital policies prohibit smoking, patients are highly motivated to quit, and societal guidelines recommend that clinicians should counsel patients and prescribe smoking cessation pharmacotherapy (SCP) to virtually all smokers. Nevertheless, only 22% of patients are ever prescribed SCP while hospitalized and only 1% of patients are prescribed guideline-concordant SCP. This failure ultimately contributes to a 70-80% smoking relapse rate, most of which occurs within a few days of hospital discharge – well before outpatient follow-up can occur. If we are to capitalize on the opportunity that hospitalization provides to maximize smoking cessation treatment and outcomes, new strategies are needed to overcome the low uptake of guideline-concordant SCP by physicians and patients. To address this problem, we propose to deploy a nurse practitioner-led, hospital- based tobacco treatment team to: 1) prescribe individually tailored and guideline-concordant SCP; 2) counsel and motivate patients to use SCP properly; and 3) and manage a mobile phone-based text-messaging system to keep patients motivated and adherent to SCP. Our preliminary data suggest that such an approach is feasible and acceptable to patients, physicians, and hospital administrators. In Aim 1, we will perform a parallel-group implementation-effectiveness randomized trial among 424 hospitalized smokers with a cardiopulmonary disease in a large tertiary hospital. We will compare rates of SCP use and smoking cessation between patients who received the intervention and those who did not. In Aim 2, we will measure the economic value of the intervention from both a hospital and payer perspective to better inform hospital and insurance policies and sustainability. In Aim 3, we will perform qualitative interviews with patients, physicians, staff members, and hospital administrators to evaluate the acceptability and sustainability of our strategies. We hypothesize that our intervention will: improve guideline-concordant SCP use; increase 6- month smoking cessation rates; be acceptable to patients, clinicians, and administrators; and be cost-effective and sustainable. Our multi-disciplinary team has broad experience in cardiopulmonary medicine, tobacco treatment, implementation science, medication adherence, qualitative methods, health economics, and text message technology. At the conclusion of this grant, our team will develop a detailed, evidence-informed implementation guide for a hospital-based tobacco treatment team. Ultimately, we anticipate the knowledge gained from this study will facilitate widespread and effective hospital-based tobacco treatment so that more patients lead lives free from tobacco and cardiopulmonary disease.