Effects of post-discharge counseling and medication utilization on short and long-term smoking cessation among hospitalized patients

Abstract

Numerous studies have tested the effect of multicomponent post-discharge smoking cessation interventions on post-discharge smoking cessation, and many are effective. However, little is known regarding the relative efficacy of the different intervention components on short or long-term cessation. The present study is a secondary analysis ( n = 984) of a randomized controlled trial for hospitalized smokers that took place at two large hospitals in Kansas from 2011 to 2014. All study participants were offered post-discharge quitline services. Pharmacotherapy was recommended during bedside tobacco treatment. The study outcomes were self-reported cessation at 1-month and biochemically verified cessation at 6-months post-randomization. During the post-discharge period, 69% of participants completed at least one quitline call and 28% of participants reported using cessation pharmacotherapy. After controlling for known predictors of cessation among hospitalized smokers, both the number of total quitline calls completed post-discharge and use of cessation pharmacotherapy post-discharge were predictive of cessation at 1-month. After accounting for predictors of cessation and quitting at 1-month, total post-discharge quitline calls was associated with cessation at 6-months ( OR [95% CI] = 1.23 [1.12, 1.35], p < 0.001) while post-discharge cessation pharmacotherapy use was not. The results suggest that both engagement in quitline services and use pharmacotherapy independently facilitate cessation beyond the influence of known clinical characteristics associated with cessation. Over the longer term, the effect of engaging in quitline services persists while the effect of pharmacotherapy diminishes. To optimize outcomes, future research should investigate methods to increase utilization of medications and promote sustained counseling engagement in order to sustain the effects of treatment during the post-discharge period.

Highlights

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  Counseling and pharmacotherapy are effective interventions for helping hospitalized smokers quit smoking, but the relative contribution of each intervention component to short or long-term abstinence is not well understood

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  This secondary analysis of a large clinical trial found that quitline counseling and pharmacotherapy – when used after hospital discharge - were associated with increased odds of quitting smoking at 1-month follow up

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  Controlling for early abstinence at 1 month, only post-discharge quitline counseling remained predictive of cessation at 6-months follow-up

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  Pharmacotherapy and quitline counseling independently facilitate short-term abstinence, while long-term abstinence is facilitated by engagement in quitline counseling services

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  Hospitals could work directly with state quitlines to integrate counseling into post-discharge care