Improving the Delivery of Smoking Cessation Guidelines in Hospitalized Veterans
The primary objective of this study is to determine whether a nurse-initiated intervention, which couples brief inpatient counseling and proactive telephone counseling by a centralized tobacco quitline, improves 6-month cessation rates in hospitalized VA smokers. If proven effective, the proposed intervention will provide a practical strategy to enhance the adoption and implementation of recommended smoking cessation procedures in VA hospitals, and will demonstrate the utility of quitlines in preventing relapse in hospitalized smokers once they leave the hospital.
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
|Official Title:||Improving the Delivery of Smoking Cessation Guidelines in Hospitalized Veterans|
- 7-day Point-prevalence Smoking Abstinence (6-month) [ Time Frame: 6 months post enrollment ] [ Designated as safety issue: No ]This is the number of patients who reported not have smoked cigarettes over the 7 days prior to the 6-month follow-up interview.
- Referrals to Quitline [ Time Frame: Assessed within 72 hours of hospital discharge ] [ Designated as safety issue: No ]
- Prescription of Recommended Pharmacotherapy for Smoking Cessation [ Time Frame: Assessed within 72 hours of hospital discharge ] [ Designated as safety issue: No ]
|Study Start Date:||May 2009|
|Study Completion Date:||August 2013|
|Primary Completion Date:||June 2013 (Final data collection date for primary outcome measure)|
No Intervention: Arm 1
Experimental: Arm 2
Behavioral: Smoking Cessation Guideline Implementation
1. Enhanced academic detailing of staff nurses (face-to-face training, feedback on group performance, and periodic check-ins with both nurse managers and peer leaders); 2. Adaptation of the computerized information system (modified nursing admission database that includes pertinent questions about smoking, computerized "quick orders" for smoking cessation medications), 3) Patient self-management support (self-help materials, fax referral of motivated patients to state quit line), and 4) nursing peer leaders on each study unit.
Although the majority of hospitalized VA smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. The primary objective of this research study is to determine whether a nurse-initiated intervention, which couples brief inpatient counseling and proactive telephone counseling by a centralized tobacco quitline, improves 6-month cessation rates in hospitalized VA smokers. Co-primary aims are to determine whether the intervention improves the prescription of recommended pharmacotherapy for smoking cessation and the referral of patients for telephone counseling (or other outpatient cessation counseling). We will perform a quasi-experimental before-after trial in hospitalized patients, aged 18 or older, who smoke at least one cigarette per day on average. After a 6-month baseline period, we will implement the intervention and enroll a separate cohort of patients over the subsequent 6 months. The intervention will include: 1) nurse training in delivery of bedside cessation counseling, 2) use of CPRS-based practice tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), 3) computerized referral of motivated inpatients for proactive telephone counseling, and 4) use of nursing peer leaders to provide coaching and performance feedback to ward nurses. Enrolled patients will be contacted by telephone at 3 and 6 months to assess 7-day point prevalence abstinence and prolonged abstinence (with biochemical confirmation of self-reported quitters at 6 months). We will identify barriers and facilitators to implementation by using clinician focus groups, and will assess attitudes of staff nurses toward cessation counseling by questionnaire. We will also conduct semi-structured interviews in a subsample of patients and nurses to assess perceptions of the intervention, and will use content analysis to interpret the data.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00816036
|United States, Colorado|
|VA Eastern Colorado Health Care System, Denver|
|Denver, Colorado, United States, 80220|
|United States, Iowa|
|VA Medical Center, Iowa City|
|Iowa City, Iowa, United States, 52246-2208|
|United States, Minnesota|
|Minneapolis VA Health Care System|
|Minneapolis, Minnesota, United States, 55417|
|United States, Nebraska|
|VA Medical Center, Omaha|
|Omaha, Nebraska, United States, 68105-1873|
|Principal Investigator:||David A. Katz, MD MSc||VA Medical Center, Iowa City|