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Use of tobacco-cessation therapy was low. The study found several negative factors - and two positive predictors.
Kathryn WheelerSmoking cessation is the most effective intervention for patients with chronic obstructive pulmonary disease (COPD), yet many patients continue to smoke even after hospitalization for an exacerbation, and treatment rates for tobacco abuse after a hospital stay are often low.
Identifying the differences between patients who receive therapy for tobacco cessation and those who do not could help improve standards for the prescribing of post-discharge tobacco-cessation therapy.
Researchers reviewed the electronic medical records in the Veterans Affairs Veterans Integrated Service Network (VISN-20) for a cohort of current smokers admitted to a hospital for a COPD exacerbation.
Researchers identified 1,511 current smokers older than 39 years of age and hospitalized between 2005 and 2012 with a primary discharge diagnosis of COPD or an admission diagnosis indicative of a COPD exacerbation. Patients without a documented smoking status or who died during admission were excluded.
Pharmacy records supplied information about which patients met the primary outcome, receipt within 48 hours of hospital discharge of medication approved to aid with smoking cessation.
Each patient’s medical record was examined for possible predictors of tobacco-cessation therapy use during the index admission and for the previous year. Sensitivity analysis reviewed the use of bupropion during and after hospital admissions, and noted inclusion of COPD diagnosis as a primary discharge diagnosis. These analyses revealed no significant differences in observed effects.
Overall findings were similar to those of other studies: Use of tobacco-cessation therapy was low.
Only 17.5% of patients in this study received tobacco-cessation therapy as an inpatient. Of these patients, only 44.7% were dispensed such therapy after discharge from the hospital.
A nicotine replacement patch was the most commonly prescribed outpatient therapy.
Investigators identified several factors associated with decreased odds of tobacco cessation.
Researchers identified two positive predictors for receipt of tobacco-cessation therapy post-discharge.
Patients who received treatment with a medication for tobacco cessation as an inpatient (OR 5.95, 95% CI 3.19-11.10) or who received discharge counseling about smoking cessation from nursing staff (OR 3.08, 95% CI 2.02-4.68) had improved odds of receiving tobacco-cessation therapy within 48 hours post-discharge.
Not sought and not found
Researchers did not address the reasons that smoking-cessation therapy so often went unprescribed.
Other concerns not addressed in the study include:
Despite these limitations, the robust documentation system employed by the VA healthcare system allows for thorough review of patient records across a variety of hospital settings for all identified smokers admitted to hospital for a COPD exacerbation.
There is a need for further study into improvement of the delivery of smoking-cessation therapies to patients after discharge. However, the positive predictors of patient use of these therapies are rooted in interventions based in healthcare systems (e.g., discharge counseling and initiation of therapies as an inpatient where smoking is prohibited).
Implementation of systemic approaches ensuring that all smokers receive these opportunities may eliminate disparities in treatment and bolster weak treatment rates.
Source: Predictors of pharmacotherapy for tobacco use among veterans admitted for COPD: The role of disparities and tobacco control processes. Melzer AC, Feemster LC, Collins MP, et al. J Gen Intern Med. 2016 Feb 22. [Epub ahead of print]
Kathryn Wheeler is associate clinical professor, Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Conn.