Hospital program helps smokers butt out
Last Updated: Tuesday, October 28, 2008 | 8:00 AM ET
CBC News
Asking patients whether they smoke and automatically offering them treatment as soon as they are seen in hospital boosts the likelihood they will quit, a cardiologist said Tuesday.
Speaking to the Canadian Cardiovascular Congress in Toronto, Dr. Andrew Pipe, a Heart & Stroke Foundation researcher, said the Heart Institute in Ottawa was able to increase smoking cessation in heart patients by 15 per cent.
The systematic approach was key to the success, said Pipe, chief of the Minto prevention & rehabilitation centre at the University of Ottawa Heart Institute.
"It wasn't left to chance," Pipe said in an interview. "In exactly the same way that somebody takes a patient's pulse and blood pressure when they're admitted to hospital, somebody must ask them about their smoking status and initiate a process whereby they get assistance."
The program includes an immediate offer of stop-smoking aids such as the patch to encourage people to quit while they are in hospital, but also coaching to deal with withdrawal symptoms, and six months of follow-up phone calls.
Societal attitudes toward smoking have changed, but the medical community seems mired in a 20th century approach, Pipe said. Part of the problem could be that doctors lack experience in treating nicotine addiction and may have under-appreciated how great an effect they can have – issues that the "Ottawa Model" counters.
Smoking is not on the radar for doctors, but it should be the top priority for reducing risk among heart patients, he urged.
At $2,000 to $6,000 per life-year saved, smoking cessation is more powerful and cost- effective at preventing cardiovascular disease than other interventions, such as reducing high blood pressure, which costs $19,000 to $26,000, Pipe noted.
The Ottawa Model has been rolled out in 25 hospitals across Canada, including British Columbia and New Brunswick, where patients who smoke are offered the program regardless of why they entered hospital.
Previously, quit-smoking programs depended on patients to drop in rather than health care workers intervening.
Participants are started on the patch while hospitalized, and the dose is adjusted as needed.
Once a patient leaves the hospital, a computer is programmed to automatically call at an agreed upon time to check whether the person is still smoke free. If the answer is no, a person calls back with strategies to tackle the problem.
Ex-smokers free of the stress of withdrawal can develop a repertoire to substitute for the smoking behaviour. For example, if someone smokes after dinner, the caller may suggest that they walk the dog at that time instead.
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