What is the best intervention to help hospitalized patients quit smoking?

Follow-up after discharge: Pharmacotherapy may be added for withdrawal control, as well as relapse prevention for the hospitalized patient who recently quit smoking. However, inclusion of intensive tobacco cessation counseling during the hospital stay is the most effective intervention given the setting and patient condition, and follow-up support up to at least one month after discharge has been found to be more effective in sustaining tobacco abstinence than pharmacotherapy alone. In order to maximize long-term quit rates among patients who recently abstained from smoking, the hospitalist should arrange access to ongoing outpatient post-discharge support and tobacco cessation treatment.

Back to the Case

After appropriate cardiac testing, the patient was found to have a non-cardiac etiology for his symptoms. From the start of his hospital stay, he was counseled by the hospitalist and started on sustained-release bupropion, but withdrawal symptoms and cravings persisted.

Prior to his discharge home, the patient wanted to discontinue bupropion and be provided an alternative. The patient was given a nicotine patch, and a follow-up appointment at the tobacco cessation clinic within one week of discharge from the hospital was arranged. The patient has been compliant with his quit-smoking treatment and has followed-up for continued tobacco cessation counseling. He hasn’t smoked cigarettes for a year. TH

Dr. Palisoc is a preventive medicine resident at the University of Colorado Denver. Dr. Prochazka works at the Denver VA and is a professor of medicine at the University of Colorado Denver.

References

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