Calls, Free Medication Help Smokers Quit After Discharge

Marcia Frellick

August 20, 2014

A postdischarge intervention that included automated telephone calls and free medication was more effective in helping adult smokers quit after leaving the hospital than standard cessation medication and counseling, according to a study published in the August 20 issue of JAMA.

At 6 months after discharge, 26% of those in the intervention group showed biochemically supported 7-day abstinence of any tobacco product, including electronic cigarettes, compared with 15% in the standard-care group (relative risk, 1.71; 95% confidence interval, 1.14 - 2.56; P = .009). Abstinence was confirmed with a saliva test to measure a nicotine metabolite at 6 months.

Nancy A. Rigotti, MD, from Massachusetts General Hospital, Boston, and colleagues enrolled 397 hospitalized daily smokers who wanted to quit smoking after discharge. They randomly assigned participants to the intervention group or to standard tobacco treatment care groups. Those in the intervention group received automated interactive voice response telephone calls at 2, 14, 30, 60, and 90 days after discharge, as well as their choice of free cessation medication (any type approved by the US Food and Drug Administration) for up to 90 days.

The telephone script encouraged participants to request a call from a counselor if they were struggling or had any problems with medications. A trained counselor returned calls, using a standardized protocol. A fax was then sent to the primary care clinician of each patient to make the doctor aware of the treatment program.

"The intervention appeared to be effective across a broad range of smokers and provided high-value care at a relatively low cost," the authors write.

Follow-up Protocols Lacking for Cessation

Maher Karam-Hage, MD, associate professor in the Department of Behavioral Science at the University of Texas M.D. Anderson Cancer Center, Houston, Texas, told Medscape Medical News the results may help encourage development of standard-of-care follow-up for smokers who have not been allowed to smoke in the hospital and who are in need of a plan to keep them from restarting smoking when they return home.

About 4 million smokers are hospitalized each year, and because all hospitals are now smoke-free, patients must temporarily abstain, the study notes.

Although some individual hospitals have postdischarge cessation programs, most are missing that transition piece, Dr. Karam-Hage said.

"[Patients] get a patch or gum and something, and they go home and go back to smoking, basically," he said.

Part of the reason for a lack of standard care for discharged smokers is that "there have not been studies that would show whether it makes a difference or not," Dr. Karam-Hage said.

He hopes this study will help change that. "They showed that it really makes a difference to follow-up with them by phone call.... It's not enough to do that in the hospital and let them go," he said.

Free medication is also key, Dr. Karam-Hage said, because copays and deductibles can be a considerable cost barrier for adhering to treatments. This study does not separate the benefits of how the interventions performed individually.

According to study authors, nicotine replacement therapy, the most widely used pharmacotherapy, is not consistently covered by insurers. In addition, free tobacco quit lines "are poorly linked to health care systems," they note.

This study was supported the National Institutes of Health/National Heart, Lung, and Blood Institute. The study is part of the Consortium of Hospitals Advancing Research on Tobacco initiative, jointly sponsored by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health Office of Behavioral and Social Science Research. TelAsk Technologies (Ottawa, Ontario, Canada) developed and provided the interactive voice response services and was compensated for this work by the National Heart, Lung, and Blood Institute. This work was supported in part by a career development award from the US Department of Veterans Affairs Clinical Sciences Research and Development Service. One coauthor reported being an unpaid consultant for Pfizer Inc and Alere Wellbeing Inc regarding smoking cessation, receiving royalties from UpToDate for reviews on smoking cessation, and receiving reimbursement for travel expenses from Pfizer to attend a consultant meeting. Another coauthor reported being a paid consultant to CVS Inc to provide expertise on tobacco policy. Another reported receiving a grant from Pfizer to provide free varenicline for use in a trial funded by the National Cancer Institute. Another reported being a paid consultant for Pfizer Inc on matters separate from smoking cessation. Dr. Karam-Hage has participated recently in a multinational smoking cessation study funded by Pfizer Pharmaceuticals and has participated in 2 National Institutes of Health funded smoking cessation studies in which the medication Chantix was provided by Pfizer.

JAMA. 2014;312:719-728. Full text

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