An Evaluation of the Systematic Identification and Treatment of Tobacco Use Among Patients in an Academic Medical Center

Abstract

Background: The Joint Commission recently developed core measures for screening and treatment of tobacco use, as hospitalization provides a good opportunity for helping patients to quit smoking. This study was undertaken to evaluate a new program that systematically identifies and offers treatment to all inpatient tobacco users at University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) in Seattle. The program was implemented in conjunction with a new tobacco-free hospital campus policy and included modifications of electronic medical record-based processes for intake screening, physician orders, nursing protocols, and a pharmacist-delivered brief intervention. Methods: Hospital records for all patients 18 years and older, admitted May 31 to December 31, 2011 were reviewed (n=22,306) to determine rates of screening for tobacco use and acceptance of nicotine replacement therapy (NRT) and counseling. Chi-square statistics were used to describe relationships between demographic variables (gender, age, race/ethnicity, insurance type, and primary admission diagnosis) and screening and acceptance rates. Results: Approximately 20% of all admitted patients screened positive for current smoking (past 30 days). Screening rate for tobacco use after policy implementation was high (79%) as was the rate for offering NRT (76.6%) and counseling (69.5%). However, less than half of tobacco-using patients (45.3%) accepted the offer of NRT and only a quarter (24.2%) accepted cessation counseling. Conclusion: While rates of screening and offering tobacco treatment (NRT and counseling) are quite high in this inpatient setting, relatively few patients take advantage of assistance for quitting tobacco. Further evaluation is needed to assess factors associated with uptake of treatment in order to increase delivery of effective tobacco cessation interventions in this setting.