TOPIC: Tobacco Cessation and Prevention
TYPE: Original Investigations
PURPOSE: Smoking cessation reduces mortality, confers morbidity benefits for the smoker and can bring about significant economic benefits for the society. Considering that smokers have varying motivational levels to quit smoking and that smoking cessation programmes can be resource and manpower intensive, the careful identification and enrollment of committed smokers into such programmes would allow the judicious use of resources to be put to the greatest effect in smoking cessation efforts. We embarked on a quality improvement project (QIP) to improve smoking cessation rates in our tertiary healthcare institution. We describe and examine the use of screening questions as an effective predictor of smoking cessation success as a pilot initiative for our QIP.
METHODS: A pharmacist-driven QIP was implemented in our hospital from September 2020 to March 2021. Centred on the transtheoretical model of behaviour change, 3 screening questions were devised to screen newly admitted patients who smoked and who would potentially benefit from the hospital’s smoking cessation programme: (1) Are you currently smoking? (2) Have you thought of quitting or cutting down on smoking? (3) Would you like to speak with someone to help you with this? As a pilot initiative, all newly admitted patients who smoke and who were admitted to the 2 pilot wards over this time period would be screened by the ward nurses. Smokers who answered “yes” to all 3 questions were assessed to be at the “preparation” phase of the transtheoretical model and would be approached by the ward pharmacist for enrollment into the hospital’s smoking cessation programme, through which appropriate interventions to quit smoking would be recommended to the smokers. Interventions offered can include counselling and nicotine replacement therapy. Each enrolled smoker would be followed up by pharmacists via telephonic and/or clinic consults and smoking cessation rates were then assessed at 3 and 6 months.
RESULTS: Out of a total of 1868 patients admitted to the 2 pilot wards, of which 207 were smokers, 37 smokers, comprising male and female patients with age ranging from 26-87 years old, were enrolled into the smoking cessation programme. 6 smokers were lost to follow-up and 1 patient was deceased. Smoking cessation rate at 3 months was 36% and 41% at 6 months. These smoking cessation rates were higher compared to smoking cessation rates at other centres in Singapore, which range from 24% to 27%. The proportion of smokers who had reduced cigarette smoking was 95% at 3 months and 91% at 6 months. Estimated economic benefits per year taking into account direct and indirect costs amount to at least US$52,210.
CONCLUSIONS: The higher smoking cessation rates seen at the 3rd and 6th month of enrollment in the smoking cessation programme compared to other local institutions may be due to the identification of smokers who are prepared to take action to quit smoking. Significant economic benefits can also be derived from the successful smoking cessation endeavours. However, further studies are required to assess the sustained outcomes and impact of screening questions in smoking cessation programmes.
CLINICAL IMPLICATIONS: Application of screening questions can help identify smokers who are prepared to take action to quit smoking. In resource conscious environments, the identification of committed smokers would enable the judicious use of resources that may yield the best chance of smoking cessation success.
DISCLOSURES: No relevant relationships by JOO WEI CHUA, source=Web Response
No relevant relationships by Nicholas Shaowen Goh, source=Web Response
No relevant relationships by Golda Wang, source=Web Response
© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.