close

Вход

Забыли?

вход по аккаунту

?

Predictors of Continued Smoking Abstinence - HPH

код для вставкиСкачать
PREDICTORS OF CONTINUED
SMOKING ABSTINENCE AMONG
HOSPITALIZED PATIENTS
Masuet Aumatell C, Ramon Torrell JM, Morchon Ramos S, Lopez Salguero GL
Health Promotion Hospitals Conference, Dublin 2005
Empowerment strategy
Better health for the patients
Better health for the HCW
A more healthy organisation
Better health for the community
Background
• No-smoking policies are mandatory in all Spanish
hospitals.
• The smoker patients require to abstain temporarily
from tobacco.
• Nevertheless 25% of hospitalised smokers report
smoking during hospital stay, although 4% of smokers
do it indoors (Rigotti, 2000). In our hospital we made a
survey in 2003 and we found 35%, and 5%
respectively.
Rigotti NA, Arnsten JH, McKool KM, Wood-Reid KM, Pasternak RC, Singer DE. Smoking by
patients in a smoke-free hospital: prevalence, predictors and implications. Prev Med 2000; 31 (2): 159-66.
Predictors of continued abstinence (review)
Author
Design
Participants
Continued Abstinence rate
Predictor factors
Rigotti (1997)
Clinical trial
Medical &
surgical
(n=650)
28.9% (1M)
-Abstinence during
17.3% (6M; 1 single session hospital stay
verbal advice + self-help material
+ 3 weekly counseling by phone)
Dale (1997)
Retrospective
analysis
Elderly people
with Medical
conditions
(n=613)
24.8% (6M; medical consultation)
Hajek (2002)
Clinical trial
Cardiovascular
(n=540)
40% (12M; 1 single session verbal -Low dependence on
advice)
tobacco
-High motivation to quit
MacKenzie
(2004)
Survey
Medical
(n=154)
18% (6M ; phone survey +NRT)
Ong (2005)
Cohort study
Cardiac &
respiratory
(n=248)
43.5% (2M; verbal advice in -Low dependence on
hospitalisation & every 2 weeks tobacco
+booklets)
-High motivation to quit
-Initial hospitalization
-Hospitalization
-Married to a non- smoking
spouse
-High motivation to quit
-The longest time of
previous abstinence <1
day or month
-High level of confidence
to quit
-Mutiple prior quit
attempts
MATERIAL AND METHODS
Objective: to determine predictors of continued smoking abstinence
30-minute bedside
counseling session
Continued abstinence
6 monthly counseling telephone calls
?%
220
-Cardiac, respiratory, surgical and medical patients
-University-affiliated hospital from January to June 2004
-Current smokers at admission
MATERIAL AND METHODS
• Outcome measurements: Continuous abstinence at six
months by self-report (not validated).
• Statistical analysis:categorical variables were studied
by chi-squared test, continuous variables by Student T
test, and the statistically significant associated were
included in a logistic regression model (step-forward).
Results
• At 6 months post-discharge, 73 (33%)
patients remained abstinent, being 43% in
cardiology ward, and 24.9% in respiratory
ward.
Con tinue d abst inence
*
Age
mean (SD)
**
Male
Female
Comorbit y
Yes
No
Hospitalization service Medical service
Cardiac service
Respiratory service
Surgical service
Tob acco depen dence Low
(Fagerstr Г¶m)
Intermediate
High
M o tivatio n
Low
Intermediate
High
Some prio r quit attempts
Yes
No
Smoker family membe rsYes
No
Sex
Start smo king' age
mean ( SD)**
Number o f cigarettes per d ay me an (SD)**
Yes n(%)
No n(%)
53.84 (13.76)
48 (88.9)
6 (11.1)
32 (59.3)
22 (40.7)
9 (17.3)
22 (42.3)
12 (23.1)
9 (17.3)
26 (49.1)
12 (22.6)
15 (28.3)
8 (17.0)
13 (27.7)
26 (55.3)
34 (75.6)
11 (24.4)
23 (46.0)
27 (54.0)
15.75 (5.88)
51.71(15.20)
131 (78.4)
36 (21.6)
78 (46.7)
89 (53.3)
47 (26.8)
29 (18.5)
39 (24.8)
47 (29.9)
60 (37.1)
53 (32.7)
49 (30.2)
67 (44.4)
48 (31.8)
36 (23.8)
72 (59.0)
50 (41.0)
94 (66.2)
48 (33.8)
15.88 (6.11)
24.81 (5.05)
24.20 (6.78)
Cru de
Odd s
Rat io
(COR)
95% CI COR
LCI
UCI
1.87
0.86
4.09
1.13
0.97
1.32
1.25
0.62
0.39
4.78
2.89
2.12
0.71
0.75
1.03
1.13
0.98
1.23
1.01
1.32
1.93
1.44
0.66
0.97
1.00
2.44
1.33
0.83
1.00
0.86
0.91
1.00
1.14
1.54
1.21
0.80
**. No statistical differences ( p-value >0.05)
*. Categorical variables compared by Chi-squared test, and continuous variables compared by Student-T test. P -value two-tailed, and statistically significant p<0.05.
Logistic regression
Adjusted
Odd s
Ratio
(AOR)
*
Age
Sex
M o tivatio n stag e
Male
Precontemplative
Contemplative
Active
Smo ker family membe rs
Some prio r atte mpts to quit
Hospitalization serviceMedical service
Cardiac service
Respiratory service
Surgical service
95% CI AOR
LCI
UCI
0.99
1.26
1.00
2.30
0.96
0.41
1.02
3.86
0.82
7.56
2.47
1.21
5.06
0.52
0.23
1.20
1.82
0.72
4.60
1.00
2.21
0.87
0.64
0.64
0.24
0.16
7.70
3.18
2.46
*. Continued abstinence adjusted by age, sex, motivation, smoker family members, some prior attempts to quit,
and hospitalization service.
Conclusion
• Among this cohort of inpatients receiving
smoking cessation intervention the motivation
stage was the only independent predictor of
smoking abstinence at 6 months after hospital
discharge being over twice as likely to maintain
the abstinence.
• On the other hand sex, the tobacco dependence,
the family smoker member, type of ward, prior
attempts to quit were not obtained as predictors.
Discussion
• Multiple session verbal advice delivered by phone
might have insufficient power to influence highly
dependent smokers, even if single one has been
demostrated to have less power (Hajek, 2002).
• Low continued abstinence rate (33%) but
comparable to other series if we considered the
cardiac (43%) and respiratory (24.9%) patients.
Hajek P, Taylor TZ, Mills P. Brief intervention during hospital admission to help patients to give up smoking after
myocardial infarction and bypass surgery: randomised controlled trial. BMJ 2002; 324 (7329): 87-9.
Discussion
• Low intensity hospital-based smoking cessation
program increase smoking cessation rates for 6
month after discharge but not lead to long-term
tobacco abstinence (Rigotti, 1997). Maybe more
than increase monthly counseling sessions by
phone might build on this initial success to
produce permanent smoking cessation.
• Reconsider the validation of abstinence by selfreport through CO, even if some organizational
problems have to be solve.
Rigotti NA, Arnsten JH, McKool KM, Wood-Reid KM, Singer DE, Pasternak RC. The use of nicotine-replacement
therapy by hospitalized smokers. Am J Prev Med 1999; 17 (4): 255-9.
Документ
Категория
Презентации
Просмотров
24
Размер файла
887 Кб
Теги
1/--страниц
Пожаловаться на содержимое документа