BY NORM TOLLINSKY
Date Published |Sept. 20, 2007

An inpatient tobacco cessation research program in northwestern Ontario is zeroing in on smokers where they are most likely to be found and most susceptible to intervention counselling.

Led by Dr. Patricia Smith, an Associate Professor at the Northern Ontario School of Medicine’s Thunder Bay campus and Dr. Scott Sellick, Associate Research Scientist & Director of Supportive Care at the Thunder Bay Regional Health Sciences Centre, the two-year study is collecting baseline data on inpatient tobacco use from 13 hospitals.

Clinical practice guidelines for addressing smoking cessation recommend that hospitals identify and document tobacco use by patients, but most of them ask the question on the confidential history and physical form used by nurses. For this study, all 13 hospitals agreed to have admitting staff pose the question.

“If you can do it at the institutional level without names attached to it, you can get an idea of what the magnitude of the problem is and the resources it would take to start addressing it,” said Smith.

“People think hospitals know how many of their patients smoke, but most of them don’t. It’s quite novel that we’ve been able to do this.”

Smith and her colleagues began collecting data in January. By the end of June, they had baseline tobacco use statistics on 90,000 patients.

“Provincially, the smoking rate is 19 per cent,” she said. “In northwestern Ontario, it’s about 26 per cent, but we’re finding much higher rates than that in hospitals because so many admissions are for smoking-related diseases.

Shocking

“Our numbers are shocking. It’s going to blow the socks off some people who are in a position to put some resources this way.”

In addition to collecting data on tobacco use by patients, hospitals are encouraged to promote smoking cessation intervention by providing health-care professionals with learning resources and training. They are also encouraged to dedicate one staff member to smoking cessation and promote supportive policies, such as including nicotine replacement therapies in hospital formularies and the enforcement of no smoking within nine metres of a hospital entrance.

As part of the study, Smith and her team will survey health-care professionals in participating hospitals to determine the extent to which the guidelines are being applied.
“We’ll be able to give the information back to the hospitals, say this is where you’re at, and make recommendations.”

Administrators and staff are “really keen,” said Smith. “They understand the health effects of smoking and see the readmissions.

“Most hospitals want to do something, but it’s an acute care system, so there aren’t a lot of resources earmarked for doing prevention. Hopefully, our work will provide a pathway for them to do more.”

A PhD in Psychology from the University of Waterloo, Smith has studied, researched and written extensively about smoking cessation strategies. Once hospitalized, she says, smokers are much more inclined to welcome an intervention.

“Anywhere between 20 to 50 per cent of general hospitalized patients accept an intervention during hospitalization and up to 80 per cent of patients with heart attacks accept a program. To put that into perspective, when we ask smokers in the general population if they would be interested in a program free of charge, less than one per cent accept.”

Hospitals are great places to quit smoking, she said. Smokers experience their worst withdrawal symptoms within two or three days of quitting, but don’t even notice them in hospital “because there’s so much else going on.”

Daily cues

They are also removed from their daily cues to smoke.

“Often, they are pretty sick, so they don’t even want to smoke and some of them can’t go outside.”

In studies she has been involved with in the past, between 25 and 30 per cent of smokers who quit remain smoke-free one year after being discharged. For heart patients, the percentage is as high as 70 per cent.

In the general population, approximately three per cent of smokers quit per year on their own. Five per cent quit if a physician advises them to do so during an office visit, seven to eight per cent quit if the physician offers nicotine replacement therapy and eight to 10 per cent quit if the physician supplements the nicotine replacement therapy with counselling.

While Smith’s research is focused on inpatient smoking cessation, she has also received calls from family health teams in northwestern Ontario asking how they can tap into her work and support patients after they are discharged from hospital.

“If we can work with family health teams, that would be wonderful,” she said
In subsequent phases of the study, Smith will be able to track the success of inpatient smoking cessation strategies by monitoring the smoking behaviour data collected by participating hospitals as part of their admissions procedure.