Integrating Tobacco Dependence Treatment into Hospital Practice Using the Rochester Model

Abstract

John C Grable,1,* Jonathan K Lin,2,* Kenneth Peltzer,1,* Rebecca Schultz,1,* Doris Bugbee,3,* Mikhail Pilipenko,3,* Scott C Levy,1,* Shayne Hawkins3,* 1Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA; 2Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA; 3Department of Nursing, University of Rochester School of Medicine, Rochester, NY, USA*These authors contributed equally to this workCorrespondence: John C Grable, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY, 14642, USA, Tel [phone], Fax [phone], Email [email protected]: Delivering evidence-based tobacco dependence treatments to hospital patients in real-world settings continues to be a challenge. To achieve long-term abstinence, a program should provide both bedside counseling and post-discharge contacts. These program features are necessary but difficult to implement due to lack of training, time and low administrative support. The Rochester Model is a tobacco treatment program using existing staff and medical students to reduce the barriers for treating hospitalized smokers.Patients and Methods: Any smoking patient admitted to a participating hospital unit can participate. Staff nurses, mid-level providers and physicians deliver the counseling steps during the admission. Nurses hold two bedside counseling sessions, while providers give quitting advice and encourage pharmacotherapy. Nurses also contribute as unit champions and post-discharge call counselors. New York State quit line counselors combined with a University of Rochester call team fulfill the post-discharge calls. The latter call team is composed of staff nurses, respiratory therapists and medical students.Results: The number of smoking patients screened was 2610 while 385 enrolled after a proof-of-concept period. The 7-day point prevalence quit rates using the as treated (patients contacted) analysis is 50% at 4 weeks, 42% at 3 months and 38% at 6 months. The 7-day point prevalence quit rates using the intent-to-treat (all patients) analysis is 23% at 4 weeks, 16% at 3 months and 14% at 6 months.Conclusion: Preliminary data on the Rochester Model is showing an effective yet affordable tobacco treatment program using hospital staff and medical students. Nurses serve as bedside counselors, unit champions and post-discharge call counselors. Hospitals, even with limited resources, can implement tobacco treatment programs using existing staff.Keywords: tobacco dependence treatment, nurse counseling, quit-line counseling, respiratory therapists, medical students

Keywords

• tobacco dependence treatment
• nurse counseling
• quit-line counseling
• respiratory therapists
• medical students