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Staying Smoke Free After Hospital Discharge

Smokers admitted to U.S. hospitals can’t smoke during their stay and could use this time as an opportunity to quit, but few are able to stay smoke-free after returning home. Now a study done at Massachusetts General Hospital and published in the August 20th 2014 issue of JAMA describes a program that increased the proportion of hospitalized smokers who successfully quit smoking after discharge by more than 70 percent. The system used interactive voice response technology – automated telephone calls – to provide support and stop-smoking medication for three months after smokers left the hospital.

A release from the hospital quotes Nancy Rigotti, MD, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital (MGH) and the lead author of the report, as saying, “Most smokers want to quit, and being hospitalized gives them an opportunity to do so because they can’t smoke in the hospital. The health problems that led to the hospital admission can give them extra incentive to stop smoking. Many smokers get advice to quit in the hospital, but they are rarely connected to resources to help them stay quit when they return home.”

The sustained care program developed by the MGH team provides smokers with a series of interactive automated telephone calls beginning two days after discharge and up to three months’ supply of the patients’ choice of any FDA-approved stop-smoking medication. At each call, the automated system asked patients to indicate whether they were smoking, gave advice on staying smoke-free, encouraged the proper use of medication and offered medication refills. Participants requesting additional help received a call back from one of the program’s tobacco treatment counselors.

The study enrolled 397 smokers who had been hospitalized at MGH, received tobacco cessation counseling as inpatients, and indicated that they planned to try quitting after discharge. Half of the group was randomly assigned to receive the sustained care program. The other half received standard care, consisting of a recommendation to use a stop-smoking drug and to call the national tobacco quitline (1-800-QUIT-NOW) for support. At one, three and six months after hospital discharge, participants received assessment calls from study staff, during which they were asked whether they were currently using any tobacco products and whether they had used any stop-smoking medication or tobacco counseling. The six-month follow-up included a biochemical test to confirm participants’ self-reports of not smoking.

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