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. 2019 Apr 24;19(1):246.
doi: 10.1186/s12913-019-4059-4.

Critical steps in the path to using cessation pharmacotherapy following hospital-initiated tobacco treatment

Edward P Liebmann  1 , Taneisha S Scheuermann  2 , Babalola Faseru  2 , Kimber P Richter  3
Affiliations

Critical steps in the path to using cessation pharmacotherapy following hospital-initiated tobacco treatment

Edward P Liebmann et al. BMC Health Serv Res. .

Abstract

Background: Hospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates. Use of smoking cessation medications following discharge may further increase quit rates. This study aims to identify individual, smoking-related and hospitalization-related predictors of engagement in three different steps in the smoking cessation pharmacotherapy utilization process: 1) receiving medications as inpatient, 2) being discharged with a prescription and 3) using medications at 1-month post-hospitalization, while accounting for associations between these steps.

Methods: Study data come from a clinical trial (N = 1054) of hospitalized smokers interested in quitting who were randomized to recieve referral to a quitline via either warm handoff or fax. Variables were from the electronic health record, the state tobacco quitline, and participant self-report. Relationships among the predictors and the steps in cessation medication utilization were assessed using bivariate analyses and multivariable path analysis.

Results: Twenty-eight percent of patients reported using medication at 1-month post-discharge. Receipt of smoking cessation medications while hospitalized (OR = 2.09, 95%CI [1.39, 3.15], p < .001) and discharge with a script (OR = 4.88, 95%CI [3.34, 7.13], p < .001) were independently associated with medication use at 1-month post-hospitalization. The path analysis also revealed that the likelihood of being discharged with a script was strongly influenced by receipt of medication as an inpatient (OR = 6.61, 95%CI [4.66, 9.38], p < .001). A number of other treatment- and individual-level factors were associated with medication use in the hospital, receipt of a script, and use post-discharge.

Conclusions: To encourage post-discharge smoking cessation medication use, concerted effort should be made to engage smokers in tobacco treatment while in hospital. The individual and hospital-level factors associated with each step in the medication utilization process provide good potential targets for future implementation research to optimize treatment delivery and outcomes.

Trial registration: Number: NCT01305928 . Date registered: February 24, 2011.

Keywords: Medication reconciliation; Patient discharge; Smoking cessation; Tobacco use cessation devices.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was obtained from the University of Kansas Medical Center Institutional Review Board. Informed consent for study participation was obtained in writing from all participants prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no completing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Schematic diagram for study path analysis The bulleted variables correspond to the independent variables in the model and the three medication-related variables correspond to the dependent variables. All arrows denote regression. In addition, each bulleted variable is a predictor of its respective outcome variable. Note. ED = Emergency department, HSI = Heaviness of Smoking Index
See this image and copyright information in PMC

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