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Addressing Tobacco Use After Hospitalization

Study finds providers are not addressing tobacco cessation at post-hospitalization outpatient visits
Hand curled into a fist smashing a pack of cigarettes on a table

February 20, 2023

Each year in the U.S., more than 3.2 million smokers are hospitalized. Counseling that begins in the hospital and continues for at least one month after discharge can improve the odds of quitting by 37%. In a recent study, researchers found that patients may be missing out on post-discharge visits as an opportunity to help them quit tobacco for good.

The transition of care for tobacco treatment between hospitalization and outpatient care is understudied. Outpatient clinicians frequently see patients shortly after hospital discharge, but they are not using this opportunity to follow up on inpatient tobacco treatment. A team of researchers at The University of Kansas Cancer Center reviewed patient records to assess post-discharge tobacco treatment follow-up for recently hospitalized smokers participating in a smoking cessation clinical trial. Their findings were published in the journal Chest

Of the 873 patient records studied, 400 had at least one outpatient visit within six weeks of discharge. The team discovered that only half of hospitalized patients who smoked and were interested in quitting discussed tobacco use with their doctor during post-discharge visits. Erica Cruvinel, PhD, MPH, research assistant professor in the Department of Population Health, was first author on the study.

“Many of the patients were initially hospitalized because of a tobacco-related disease, and so we hypothesized that tobacco cessation would be discussed at every follow-up visit. Instead, just half of the patients talked about tobacco cessation with their providers.” Dr. Cruvinel said. 

Only one in four participants had documented discussions regarding pharmacotherapy, such as varenicline. According to current guidelines, all tobacco users should receive pharmacotherapy as part of their quit plan.

Addressing tobacco use during outpatient visits varied by specialty. Cardiologists were the most likely to address tobacco use, broaching the topic in about 68% of follow-up visits. Tobacco use was addressed in 45% of visits with general internal medicine providers, 35% of family medicine visits, 24.3% of oncology visits and 9% of surgery visits.

Despite study findings, Dr. Cruvinel says that post-discharge visits are still a viable way for providers to help patients quit tobacco. Potential ways to ensure effective care transitions for tobacco treatment include ensuring that patients leave the hospital with a prescription, providing tobacco treatment recommendations in the hospital discharge summary, connecting the patient to outpatient tobacco treatment, increasing reimbursement rates for tobacco treatment and requiring insurance providers to cover treatment for tobacco use disorder. 

“Addressing tobacco use in post-discharge visits could be a sustainable way to provide continuity of tobacco treatment to our patients, and ensure they receive the support they need to quit,” Dr. Cruvinel said. 

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