Smoking cessation for hospitalized smokers: An evaluation of the “Ottawa Model”

Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7.
Nicotine & Tobacco Research (Impact Factor: 3.3). 11/2009; 12(1):11-8. DOI: 10.1093/ntr/ntp165
Source: PubMed


Interventions for hospitalized smokers can increase long-term smoking cessation rates. The Ottawa Model for Smoking Cessation (the "Ottawa Model") is an application of the "5 A's" approach to cessation, customized to the hospital setting. This study evaluated the impact of implementing the Ottawa Model in 9 hospitals in eastern Ontario.
The RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was used to evaluate the intervention. Trained outreach facilitators assisted 9 hospitals to implement the Ottawa Model; program delivery was then monitored over a 1-year period using administrative data and data from a follow-up database. A before-and-after study was conducted to gauge the effect of the Ottawa Model program on cessation rates 6 months after hospitalization. Self-reports of smoking cessation were biochemically confirmed in a random sample of patients, and all cessation rates were corrected for potential misreporting.
Sixty-nine percent of the expected number of smokers received the Ottawa Model intervention. Controlling for hospital, the confirmed 6-month continuous abstinence rate was higher after, than before, introduction of the Ottawa Model (29.4% vs. 18.3%; odds ratio = 1.71, 95% CI = 1.11-2.64; Z = 2.43; I(2) = 0%; p = .02). The intervention was more likely to accomplish counseling for smokers than delivery of medications or postdischarge follow-up. Attitudinal, managerial, and environmental challenges to program implementation were identified.
Trained outreach facilitators successfully implemented the Ottawa Model in 9 hospitals leading to significantly higher long-term cessation rates. The public health implications of systematic cessation programs for hospitalized smokers are profound.

Download full-text


Available from: Robert D Reid, Apr 03, 2014
20 Reads
  • Source
    • "The Framework Convention on Tobacco Control (FCTC) also endorses smoke-free environments and the provision of smoking cessation aids as the most comprehensive and suitable policies that hospitals can adopt to effectively reduce smoking (WHO, 2008). Indeed , smoke-free hospitals have the opportunity to provide tobacco cessation treatments to hospitalised patients and employees who smoke in a favourable healthy environment (Carlfjord, Kristenson, & Lindberg, 2011; Global Network for Tobacco Free Health Care Services (ENSH); Reid et al., 2010; Ripley-Moffitt, Viera, Goldstein, Steiner, & Kramer, 2010). Hospitals that provide adequate access and support for smokers increase smokers' attempts to quit, improve cessation rates, and reduce medical expenditures (Reda, Kotz, Evers, & van Schayck, 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The provision of smoking cessation interventions in hospitals has been strongly recommended. The aim of this study is to determine the maintenance of smoking cessation programmes for inpatients and hospital workers in hospitals of Catalonia (Spain) seven years after the implementation of a Tobacco Cessation Programme. A cross-sectional survey was conducted in all hospitals that offer public service in Catalonia, Spain (n=73). An online questionnaire was sent to all coordinators of the smoke-free hospital project or managers of each hospital. The survey included questions about the type of hospital, type of programmes implemented and availability and source of smoking cessation drugs. Responses to the questionnaire were submitted by 58 hospitals (79.5%). 74% and 93.1% of the hospitals had smoking cessation programmes for inpatients and workers, respectively. Most of the hospitals maintained the programmes and started routinely buying smoking cessation drugs after a period of receiving them free-of-charge. However, 17.2% of the hospitals refused to buy these drugs and 24% never had these drugs available. Through a supportive Tobacco Cessation Programme, most hospitals have smoking cessation programmes for both patients and workers. Most of them have incorporated smoking cessation drugs as a regular resource in their services' portfolio. The lack of these resources may jeopardise the maintenance of well-established programmes in hospitals. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Addictive Behaviors 11/2014; 42C:136-139. DOI:10.1016/j.addbeh.2014.11.028 · 2.76 Impact Factor
  • Source
    • "Given published findings that smoking rates among hospitalized patients exceed general population rates [4,5,32-35], the estimated current rate of smoking in Alabama (22.5%) [2], and the UAB Hospital 2009 data (24% to 32%, depending on the ICD-9 codes used to define current smokers), we estimate that at least 24% of UAB Hospital inpatients will be current smokers. Among hospitalized smokers in other studies, 60% to 82% desired to quit and expressed willingness for post-hospitalization smoking cessation contact [4,33,36]. Almost 62% of Alabama households have internet access [15]; we anticipate 50% of our hospitalized patients who smoke will have internet access, given the likelihood of being from a lower socioeconomic status. Based on current admission trends, we expect an average of 10 new patients to meet eligibility criteria on a typical day within the 27 PCAs targeted, with at least half willing to receive information about the study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: E-health tools are a new mechanism to expand patient care, allowing supplemental resources to usual care, including enhanced patient-provider communication. These applications to smoking cessation have yet to be tested in a hospitalized patient sample. This project aims to evaluate the effectiveness and cost-effectiveness of a tailored web-based and e-message smoking cessation program for current smokers that, upon hospital discharge, transitions the patient to continue a quit attempt when home (Decide2Quit). A randomized two-arm follow-up design will test the effectiveness of an evidence- and theoretically-based smoking cessation program designed for post-hospitalization. A total of 1,488 patients aged 19 or older, who smoked cigarettes in the previous 30 days, are being recruited from 27 patient care areas of a large urban university hospital. Study-eligible hospitalized patients receiving usual tobacco cessation usual care are offered study referral. Trained hospital staff assist the 744 patients who are being randomized to the intervention arm with registration and orientation to the intervention website. This e-mail and web-based program offers tailored messages as well as education, self-assessment and planning aids, and social support to promote tobacco use cessation. Condition-blind study staff assess participants for tobacco use history and behaviors, tobacco use cost-related information, co-morbidities and psychosocial factors at 0, 3, 6, and 12 months. The primary outcome is self-reported 30-day tobacco abstinence at 6 months follow-up. Secondary outcomes include 7-day point prevalence quit rates at 3-, 6-, and 12-month follow-up, 30-day point prevalence quit rates at 3 and 12 months, biologically confirmed tobacco abstinence at 6-month follow-up, and multiple point-prevalence quit rates based on self-reported tobacco abstinence rates at each follow-up time period. Healthcare utilization and quality of life are assessed at baseline, and 6- and 12-month follow-up to measure program cost-effectiveness from the hospital, healthcare payer, patient, and societal perspectives. Given the impact of tobacco use on medical resources, establishing feasible, cost-effective methods for reducing tobacco use is imperative. Given the minimal hospital staff burden and the automated transition to a post-hospitalization tailored intervention, this program could be an easily disseminated approach. Trial registration Current Intervention Trial NCT01277250
    Trials 08/2012; 13(1):123. DOI:10.1186/1745-6215-13-123 · 1.73 Impact Factor
  • Source
    • "A small pilot trial assessing the model produced a non-significant increase in one-year point prevalence quit rates over usual care, from 35% to 46%, but the trial was underpowered [27]. The Ottawa Model was subsequently expanded for use with all hospitalized smokers and, in a non-randomized pre-post study it was successfully implemented as a comprehensive program for smokers who were admitted to nine general hospitals in Ontario, Canada [28]. Six-month continuous quit rates increased from 18% before to 29% after implementation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background A hospital admission offers smokers an opportunity to quit. Smoking cessation counseling provided in the hospital is effective, but only if it continues for more than one month after discharge. Providing smoking cessation medication at discharge may add benefit to counseling. A major barrier to translating this research into clinical practice is sustaining treatment during the transition to outpatient care. An evidence-based, practical, cost-effective model that facilitates the continuation of tobacco treatment after discharge is needed. This paper describes the design of a comparative effectiveness trial testing a hospital-initiated intervention against standard care. Methods/design A two-arm randomized controlled trial compares the effectiveness of standard post-discharge care with a multi-component smoking cessation intervention provided for three months after discharge. Current smokers admitted to Massachusetts General Hospital who receive bedside smoking cessation counseling, intend to quit after discharge and are willing to consider smoking cessation medication are eligible. Study participants are recruited following the hospital counseling visit and randomly assigned to receive Standard Care or Extended Care after hospital discharge. Standard Care includes a recommendation for a smoking cessation medication and information about community resources. Extended Care includes up to three months of free FDA-approved smoking cessation medication and five proactive computerized telephone calls that use interactive voice response technology to provide tailored motivational messages, offer additional live telephone counseling calls from a smoking cessation counselor, and facilitate medication refills. Outcomes are assessed at one, three, and six months after hospital discharge. The primary outcomes are self-reported and validated seven-day point prevalence tobacco abstinence at six months. Other outcomes include short-term and sustained smoking cessation, post-discharge utilization of smoking cessation treatment, hospital readmissions and emergency room visits, and program cost per quit. Discussion This study tests a disseminable smoking intervention model for hospitalized smokers. If effective and widely adopted, it could help to reduce population smoking rates and thereby reduce tobacco-related mortality, morbidity, and health care costs. Trial registration United States Clinical Trials Registry NCT01177176.
    Trials 08/2012; 13(1):124. DOI:10.1186/1745-6215-13-124 · 1.73 Impact Factor
Show more