Tobacco Use Disorder
Conditions
Keywords
Cardiovascular Diseases, Peripheral Vascular Diseases, Cerebrovascular Stroke, Lung Diseases, Obstructive, Asthma, Tobacco Use Disorder, Smoking, Smoking Cessation
Brief summary
The Smoking Termination Opportunity for inPatients, (STOP) project is designed to capture the opportunity that is provided by admission for acute smoking related illness, to assist patients through withdrawal by use of a combination of: * the new medication Champix with * best practice counselling * initiated in an inpatient setting to achieve: * sustained smoking abstinence * reduced hospital bed and health service utilisation * reduced inpatient smoking and craving prior to discharge
Detailed description
A national standard in public hospitals for the management of smoking in patients admitted with smoking related acute illnesses is lacking. Where such patients have continued to smoke up until the time of admission, it can be assumed that primary prevention has failed. Once admitted, there is a vastly under-utilised opportunity, by use of a structured and systematic approach, to intervene with a secondary prevention attempt. This takes advantage of the synergy of: 1. the smoker is a captive audience and may be receptive to considering lifestyle factors that have lead to the admission, and 2. best practice medication and counselling can be initiated prior to discharge. If proven to be cost-effective in our analysis, a systematic roll-out of this secondary prevention initiative would be advocated. ie translation of research into practice.
Interventions
DRUGChampix
Standard MIMS dosage (including period of titration) will be used. 0.5mg daily for 3 days 0.5mg b.d. for 4 days 1mb b.d. for 70 days (full course 3 months)
BEHAVIORALCounselling alone
Quit SA 5A counselling over the phone. Maximum 8 calls over a 3 month period
Sponsors
The Queen Elizabeth Hospital
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
20 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Smoker of at least 10 cigarettes per day on average over the past 12 months * Inpatient with an anticipation admission of at least one day * Willingness to quit smoking * Aged between 20 and 75 years * A plan of discharge to go home * Acute hospital admission with cardiovascular, cerebrovascular, peripheral vascular diseases or airways (asthma and/or Chronic Obstructive Pulmonary disease
Exclusion criteria
* Subject preference to use an alternative pharmacotherapy for smoking cessation * Respiratory patient being considered for home oxygen * Pregnancy * Breast feeding * Acute or pre-existing severe psychiatric illnesses * Past history of psychosis or suicidal ideation * Renal impairment with creatinine clearance \<30ml/min
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Smoking abstinence | one year | Continued smoking abstinence is defined as: less than or equal to no more than 5 cigarettes smoked during the period of 2 weeks to 12 months post enrollment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Reduced hospital bed utilisation | one year | Hospital casemix/DRG data will be collected for the 5 years prior to enrollment and one year post enrollment. This will be supplemented by SA Department of Health data and PBS/MBS data sets of study completion, to monitor admissions at other hospitals and GP visits. |
| 7-day point prevalence | from 2 weeks to 3 months post enrollment | Defined as no cigarettes for the previous 7 days |
| Reduction in health care costs | one year | Reduced health care costs with greater economic value will be relative to other health interventions. Four seperate economic models will be built for vascular diseases: cardiovascular, cerebrovascular and peripheral vascular diseases and airways diseases: asthma and/or chronic obstructive pulmonary disease. Each model will compare outcomes and costs for varenicline and counselling compared to counselling alone, and will incorporate epidemiological data on natural disease progression of smokers and previous smokers from the four disease profiles split by gender if indicated. |
| Inpatient craving levels | baseline to end of inpatient stay | Craving scales will be used to assess levels during inpatient stay (pre and post intervention delivery) |
| Prevalence of inpatient smoking | From baseline to end of inpatient stay | Measured by self-report and observation by hospital and study staff prior to discharge. |
Countries
Australia
Outcome results
None listed