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Smoking cessation with hospital in-patients
Nancy A. Rigotti, MD Director, Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
Abstract
Hospitalisation provides a window of opportunity for initiating smoking cessation interventions. Smoke-free hospital policies require smokers to abstain temporarily from tobacco use. Illness, especially if smoking-related, increases smokers' motivation to attempt to quit. Hospital-based tobacco treatment services can access smokers at this teachable moment. A substantial body of evidence demonstrates that initiating tobacco treatment in the hospital increases smoking cessation rates after hospital discharge, but only if the intervention contacts continue for at least one month after hospital discharge. Hence, what used to be called hospital-based intervention is now more appropriately labeled hospital-initiated intervention. The evidence supports the use of both counseling and pharmacotherapy for hospitalised smokers and indicates that interventions are effective when applied broadly to all hospitalised smokers, regardless of admitting diagnosis. The evidence was recently reviewed by Dr. Rigotti and colleagues for an updated Cochrane Collaboration systematic review of hospital smoking intervention that will be released in summer 2007. The findings of this report will be summarized in the presentation. In the U.S., offering smoking cessation advice or counseling to smokers admitted for acute myocardial infarction, congestive heart failure, and pneumonia became a hospital quality of care standard in 2002. Hospital regulatory organizations and Medicare (government payor for the elderly) now monitor and publicly report this information. This regulatory change has stimulated unprecedented and widespread interest by U.S. hospitals in addressing smoking. Nonetheless, translating the evidence into routine hospital practice has several challenges. The presentation will describe Dr. Rigotti's experience implementing a model system designed to surmount these challenges.
Biography
Nancy Rigotti, M.D., is Associate Professor of Medicine at Harvard Medical School and Harvard School of Public Health. She is a board-certified internist and practicing primary care physician in Boston, MA, USA. She has 25 years' experience in developing, testing, and implementing strategies to treat tobacco dependence in health care settings. She was a pioneer in developing the evidence-based tobacco treatment strategies that clinicians now use. Target populations for her work include hospitalized smokers and outpatients who are seen for prenatal, pediatric, psychiatric, or primary care. She also develops and evaluates system-level interventions to translate effective tobacco treatments into routine practice in health care systems. Dr. Rigotti is a Past President of the Society for Nicotine and Tobacco Research, a Deputy Editor of the journal Nicotine and Tobacco Research, an author and Scientific Editor for past U.S. Surgeon General's Reports on Smoking, and has received numerous awards for her work from professional societies. She founded and directs the Tobacco Research and Treatment Center at Massachusetts General Hospital and Harvard Medical School, which aims to reduce the prevalence of tobacco use by combining clinical care, training, and scientific investigation.
Nancy A. Rigotti, MD
Director, Tobacco Research and Treatment Center,
Massachusetts General Hospital, Harvard Med School
Staniford Street, 9th floor
Boston
MA
02114
USA
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