20 August 2014. Researchers at Massachusetts General Hospital in Boston found a combination of free medications and repeated automated telephone calls sharply cuts smoking rates among discharged patients, compared to patients receiving the standard counseling before leaving the hospital. The findings of the team led by Nancy Rigotti, director of Mass. General’s Tobacco Research and Treatment Center, appear in today’s issue of the Journal of the American Medical Association.
Rigotti and colleagues studied cigarette smokers among the patient population admitted to Mass. General, a teaching hospital affiliated with Harvard University, who are prohibited from smoking while at the hospital. Many of those admitted for reasons related to smoking want to quit, but find it hard to quit once returned to their normal lives. “Many smokers get advice to quit in the hospital,” says Rigotti in a hospital statement, “but they are rarely connected to resources to help them stay quit when they return home.”
The study was organized as a clinical trial testing an intensive follow-up smoking cessation program against the current standard of care. Mass. General recruited 397 adult smoker patients, who received cessation counseling while at the hospital from 2010 to 2012 and indicated a desire to stop smoking. The group was then randomly divided between patients taking part in an intensive cessation program and those receiving the standard recommendations of medications to help stop smoking and access to a toll-free telephone number for advice.
The intensive smoking cessation program consists of a free 30-day supply of FDA-approved drugs, such as nicotine patches and lozenges, which the patients could refill twice during the following 90 days. Patients also receive 5 automated voice-response telephone calls beginning at 2 days and ending at 90 days following discharge. The automated messages provide advice and support, and offer a talk with a live counselor, particularly if participants resume smoking, or have problems using or refilling their medications.
The trial looked primarily at the ability of participants to remain tobacco-free for 7 days at 6 months following discharge, measured by reports from participants, and verified by a saliva sample mailed back to the hospital. The results show 26 percent of discharged patients taking part in the intensive follow-up program were able to quit for 7 straight days after 6 months, compared to 15 percent for those receiving the standard counseling, a statistically reliable difference. Quit rates were generally consistent across demographic subgroups, although non-whites in the program were more likely to quit (38%) than whites (22%).
The Mass. General team calculated as well costs to the hospital of the intensive cessation program. The researchers calculate the program cost about $540 per patient in the first year, when one-time start-up expenses were incurred, and $294 in each of the subsequent years. When computing the cost for each patient that quits, however, the costs rise to $4,910 in the first year and $2,670 in the following years. Since the Affordable Care Act requires insurers to cover costs of smoking-cessation drugs, the cost to the hospital for each patient that quits should drop to $3,217 in the first year and $997 in subsequent years.
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