Do hospitals do enough to help smokers quit?

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Nearly every smoker hospitalized in the United States is given advice or counseling on how to quit, according to a new study of hospital records.

But that finding belies what researchers consider a failed attempt, initiated nine years ago, at getting hospitals to actually help people stop smoking. The next version of the program needs to do better, experts say.

“There was no requirement, other than a box to check off that any substantive counseling was given to help smokers to quit,” Dr. Michael Fiore, director of the Center for Tobacco Research and Intervention at the University of Wisconsin, told Reuters Health. He was not involved in the current study but chairs a panel working to revise the hospital rules on smokers.

In 2002, the Centers for Medicare and Medicaid Services and The Joint Commission, which sets hospital standards, required that smokers discharged after having pneumonia, heart attack or heart failure be given quitting advice.

It was almost too simple a request, said Douglas Levy, lead author of the new study and a professor at Harvard Medical School and the Mongan Institute for Health Policy at Massachusetts General Hospital.

“There are anecdotal reports of hospitals putting a postcard in the patient’s room saying, ‘you should quit smoking’ and checking off the box that they’ve provided smoking cessation advice or counseling,” Levy told Reuters Health.

Levy and his colleagues collected information from the Centers for Medicare and Medicaid Services on how often hospitals provided quitting advice to patients.

Their study, published in the Archives of Internal Medicine, shows how readily hospitals adopted the new measure.

In 2002, just 67 percent of smokers hospitalized because of a heart attack received advice on quitting smoking.

By 2008, that number jumped to 99 percent of heart attack patients.

For heart failure patients, 42 percent admitted to the hospital in 2002 received smoking cessation information, compared to 97 percent of patients in 2008.

Similarly for pneumonia patients, 37 percent of them were advised to quit smoking in 2002, compared to 95 percent in 2008.

The numbers show that hospitals paid attention to the rules, but the rules were too easy to satisfy, Levy said.

The Joint Commission recognized that the requirements were not strict enough, and they put together an advisory panel in 2009 to revise the rules. One of the study’s authors sits on the panel.

Fiore, the panel’s chairman, said one of the changes coming out in 2012 is that hospitals will have to follow up with people 30 days after they are discharged to check whether the patients were able to quit smoking.

In this way, hospitals can better gauge how well their efforts are paying off.

Levy’s results don’t show whether the higher rates of quitting advice resulted in more people quitting smoking.

Take-home advice from hospitals doesn’t always change outcomes. Another recent study showed that hospitals that set up children and their families with a plan for managing asthma did not reduce later hospital visits for the condition (see Reuters Health story of October 4, 2011).

Fiore said he expects the new rules to be more effective at helping hospitals seize the opportunity to get smokers to quit.

Hospitals will also be required to document their efforts in more detail.

But Levy said some of his results left him concerned that certain hospitals may struggle under the stricter requirements.

The small numbers of patients who did not receive any advice on how to quit smoking were clustered at hospitals that serve a greater proportion of poor, minority or frail patients.

If these hospitals are not meeting the standards “when the bar is set low, it’s going to be harder for them when the bar is set higher,” Levy said.

He added that it will be important to make sure the most vulnerable hospitals don’t fall behind.

SOURCE: Archives of Internal Medicine, October 10, 2011.

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