Implementing Effective Smoking Cessation Pharmacotherapy for Hospitalized Smokers with Cardiopulmonary Disease

项目摘要 烟草使用仍然是美国死亡的主要原因， 每年住院。住院治疗提供了一个关键的干预窗口：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 为患者提供咨询，并为几乎所有吸烟者提供戒烟药物治疗（SCP）。 然而，只有22%的患者在住院期间使用过SCP， 规定的指南一致性SCP。这种失败最终导致70-80%的吸烟复发率， 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提供的机会最大限度地戒烟， 治疗和结果，需要新的策略来克服指南一致性SCP的低吸收 医生和病人。为了解决这个问题，我们建议部署一个由护士长领导的医院- 基于烟草治疗团队：1）开个体定制和指南一致的SCP; 2）咨询 鼓励患者正确使用SCP; 3）管理基于移动的手机短信系统 让患者保持积极性并坚持SCP。我们的初步数据表明，这种方法是 患者、医生和医院管理者都能接受。 在目标1中，我们将在424名患者中进行平行组实施有效性随机试验 一名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的比率 使用和戒烟的患者谁接受了干预和那些谁没有。在目标2中， 我们将从医院和付款人的角度来衡量干预的经济价值， 为医院和保险政策以及可持续性提供信息。在目标3中，我们将进行定性访谈， 患者、医生、工作人员和医院管理人员，以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将：改善指南一致的SCP使用;增加6- 月戒烟率;患者、临床医生和管理人员可以接受;并且具有成本效益 和可持续性。 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，有证据的实施方案， 医院烟草治疗小组指南。最终，我们预计从中获得的知识 研究将促进广泛和有效的以医院为基础的烟草治疗，使更多的病人能够活下去 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.