Journal Information
Vol. 47. Issue 1.
Pages 3-9 (January 2011)
Share
Share
Download PDF
More article options
Vol. 47. Issue 1.
Pages 3-9 (January 2011)
Original Article
Full text access
Effectiveness of a Cognitive Orientation Program With and Without Nicotine Replacement Therapy in Stopping Smoking in Hospitalised Patients
Efectividad de un programa de orientación cognitiva con y sin tratamiento sustitutivo con nicotina en la cesación tabáquica en pacientes hospitalizados
Visits
4192
Francisco Ortega
Corresponding author
med000521@saludalia.com

Corresponding author.
, Arturo Vellisco, Eduardo Márquez, José Luis López-Campos, Ana Rodríguez, María de los Ángeles Sánchez, Emilia Barrot, Pilar Cejudo
Sección de EPOC y Rehabilitación Respiratoria, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Abstract
Introduction

We have analyzed the effectiveness of high-intensity cognitive-behavioral intervention initiated during hospitalization, compared with minimal intervention. We have also analyzed whether the combination of intervention with nicotine replacement therapy (NRT) can increase smoking abstinence rates after 12 months of follow-up.

Methods

We studied 2,560 active smokers during their hospital stays. Of these, 717 smokers declined to participate in the study, and after minimal intervention they were asked for permission to telephone them one year later to ask if they continued to smoke. The remaining 1,843 smokers received high-intensity cognitive therapy and were randomized to receive NRT or not. The follow-up after hospital discharge was completed either in the outpatient consultation or by telephone sessions.

Results

One year later, 7% of the patients who declined to participate in the study maintained smoking abstinence, compared with 27% of those who did participate in the study (p<0.001). There were significant differences between the group that only received behavioral treatment (21% abstinence) compared with the group that also received NRT (33% abstinence; p = 0.002). In this last group, there were significant differences (p = 0.03) between those who attended outpatient consultation (39% abstinence) and those who had telephone sessions (30%). In the multivariate analysis, the predictors for abstinence 12 months later were: having used NRT (OR 12.2; 95% CI, 5.2-32; p = 0.002) and a higher score on the Richmond test (OR 10.1; 95% CI, 3.9-24.2; p = 0.01).

Conclusions

Cognitive orientation interventions initiated in hospitalized smokers increase 12-month abstinence rates compared with minimal intervention, and said rates increase significantly when NRT is added.

Keywords:
Smoking cessation
Cognitive-behavioral treatment
Nicotine replacement therapy
Hospitalization
Resumen
Introducción

Analizamos la eficacia de una intervención conductual-cognitiva de alta intensidad frente a una intervención mínima iniciada durante un ingreso hospitalario, y si la combinación con tratamiento sustitutivo con nicotina (TSN) puede aumentar las tasas de abstinencia a los 12 meses de seguimiento.

Método

Se estudiaron 2.560 fumadores activos durante un ingreso hospitalario. De ellos, 717 fumadores rehusaron entrar en el estudio y tras una intervención mínima se les solicitaba poder telefonearlos al año para preguntar si continuaban fumando. El resto, 1.843 fumadores recibieron tratamiento cognitivo de alta intensidad y fueron aleatorizados para recibir o no TSN. El seguimiento tras el alta se realizaba en consultas externas o con sesiones telefónicas.

Resultados

Al año de seguimiento, el 7% de los que rehusaron entrar en el estudio se mantenían sin fumar frente al 27% de los que entraron en el estudio (p < 0,001). Existían diferencias significativas entre el grupo que realizó solo tratamiento conductual (21% de abstinencia) frente al grupo que además realizó TSN (33% de abstinencia; p = 0,002). En este último grupo existían diferencias significativas (p = 0,03) entre los que realizaron el seguimiento en consultas (39% de abstinencia) frente a los que hicieron el control telefónico (30%). En el análisis multivariante, los predictores de abstinencia a los 12 meses fueron: haber utilizado TSN (OR 12,2; 95% de CI, 5,2–32; p = 0,002) y mayor puntuación en el test de Richmond (OR 10,1; 95% de CI, 3,9–24,2; p = 0,01).

Conclusiones

Una intervención de orientación cognitiva iniciada en fumadores ingresados aumenta las tasas de abstinencia a los 12 meses frente a una intervención mínima, y aún aumenta de forma más significativa dichas tasas si se le añade TSN.

Palabras clave:
Deshabituación tabáquica
Tratamiento conductual
Tratamiento sustitutivo con nicotina
Estancia hospitalaria
Full text is only aviable in PDF
References
[1.]
Encuesta Nacional de Salud 2003. Available from URL: http://www.ine.es/prensa.
[2.]
J.R. Banegas, L. Díez, J. González, F. Villar, F. Rodríguez.
La mortalidad atribuible al tabaquismo comienza a descender en España.
Med Clin, 124 (2005), pp. 769-771
[3.]
J. Foulds, K.K. Gandhi, M.B. Steimberg.
Factors associated with quitting smoking at a tobacco dependence treatment clinic.
Am J Health Behav, 30 (2006), pp. 400-412
[4.]
N. Haapanen-Niemi, S. Miilunpalo, I. Vuori, M. Pasanen, P. Oja.
The impact of smoking, alcohol consumption, and physical activity on use of hospital services.
Am J Public Health, 89 (1999), pp. 691-698
[5.]
Tabaquismo y nueva normativa antitabaco 2005. Centro de Investigaciones Sociológicas CIS. Available from URL: http://www.cis.es/cis/opencms/ES/1_encuestas/estudios.
[6.]
T.D. MacKenzie, R.I. Pereira, P.S. Mehler.
Smoking abstinence after hospitalization: predictors of success.
Prev Med, 39 (2004), pp. 1087-1092
[7.]
K.C. Ong, G.N. Cheong, L. Prabhakaran, A. Earnest.
Predictors of success in smoking cessation among hospitalized patients.
[8.]
N.A. Rigotti, J.H. Arnsten, K.M. McKool, K.M. Wood-Reid, R.C. Pasternak, D.E. Singer.
Smoking by patients in a smoke-free hospital: prevalence, predictors, and implications.
Prev Med, 31 (2000), pp. 159-166
[9.]
Rigotti NA, Munafo MR, Stead LF. Intervenciones para el abandono del hábito de fumar en pacientes hospitalizados. In: Biblioteca Cochrane Plus, 2008 No. 4. Oxford: Update Software Ltd. Available from: http://www.update-software.com.
[10.]
J.A. Simon, T.P. Carmody, E.S. Hudes, E. Snyder, J. Murray.
Intensive smoking cessation counseling versus minimal counseling among hospitalized smokers treated with transdermal nicotine replacement: a randomized trial.
Am J Med, 114 (2003), pp. 555-562
[11.]
C.A. Jiménez-Ruiz, J.A. Riesco, A. Ramos, M. Barrueco, S. Solano, J.I. De Granda, et al.
Recomendaciones para el tratamiento farmacológico de tabaquismo. Propuesta de financiación.
Recomendaciones SEPAR. Sociedad Española de Neumología y Cirugía Torácica, Elsevier Doyma, (2007),
[12.]
T.J. Payne, P.O. Smith, L.M. McCracken, W.C. McSherry, M.M. Antony.
Assessing nicotine dependence, a comparison of the Fagerström Tolerance Questionnaire (FTQ) with the Fagerström Test for Nicotine Dependence (FTND) in a clinical sample.
Addict Behav, 19 (1994), pp. 307-317
[13.]
R.L. Richmond, L. Kehoe, I.W. Webster.
Multivariate models for predicting abstention following intervention to stop smoking by general practitioners.
Adiction, 88 (1993), pp. 1127-1135
[14.]
D.J. Hennrikus, H.A. Lando, M.C. McCarty, D. Klevan, N. Holtan, J.A. Huebsch, et al.
The TEAM Project: the effectiveness of smoking cessation interventions with hospital patients.
Prev Med, 40 (2005), pp. 249-258
[15.]
A. Molyneux, S. Lewis, U. Leivers, A. Anderton, M. Antoniak, A. Brackenridge, et al.
Clinical trial comparing nicotine replacement therapy (NRT) plus brief counselling, brief counselling alone, and minimal intervention on smoking cessation in hospital inpatients.
Thorax, 58 (2003), pp. 484-488
[16.]
C. Bolman, H. De Vries, G. Van Breukelen.
A minimal-contact intervention for cardiac inpatients: long-term effects on smoking cessation.
Prev Med, 35 (2002), pp. 181-192
[17.]
A. Sood, J. Andoh, S. Verhulst, M. Ganesh, B. Edson, P. Hopkins-Price.
“Real-World” effectiveness of reactive telephone counseling for smoking cessation. A randomized controlled trial.
Chest, 136 (2009), pp. 1229-1236
[18.]
E. Lichtenstein, R.E. Glasgow, H.A. Lando, D.J. Ossip-Klein, S.M. Boles.
Telephone counseling for smoking cessation.
Health Educ Res, 11 (1996), pp. 243-257
[19.]
J. Ockene, J. Kristeller, R. Goldberg, I. Ockene, P. Merrian, S. Barret, et al.
Smoking cessation and severity of disease: the Coronary Artery Smoking Intervention Study.
Health Psychol, 11 (1992), pp. 119-126
[20.]
M. Barrueco, C. Jiménez Ruiz, L. Palomo, M. Torrecilla, P. Romero, J.A. Riesco.
Veracidad de la respuesta de los fumadores sobre su abstinencia en las consultas de deshabituación tabáquica.
Arch Bronconeumol, 41 (2005), pp. 135-140
[21.]
N.A. Rigotti, J.H. Arnsten, K.M. Mckool, K.M. Wood-Reid, D.E. Singer, R.C. Pasternak.
The use of nicotine-replacement therapy by hospitalized smokers.
Am J Prev Med, 17 (1999), pp. 255-259
[22.]
R. Mahrer-Imhof, E.S. Froelicher, W.W. Li, K.M. Parker, N. Benowitz.
Women’s initiative for nonsmoking (WINS V): under-use of nicotine replacement therapy.
Heart Lung, 31 (2002), pp. 368-373
[23.]
M.C. Chouinard, S. Robichaud-Ekstrand.
The effectiveness of a nursing inpatient smoking cessation program in individuals with cardiovascular disease.
Nurs Research, 54 (2005), pp. 243-254
[24.]
S.M. Mohiuddin, A.N. Mooss, C.B. Hunter, T.L. Grollmes, D.A. Cloutier, D.E. Hilleman.
Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease.
Chest, 131 (2007), pp. 446-452
[25.]
N.A. Rigotti, A.N. Thorndike, S. Regan, K. McKool, R.C. Pasternak, Y. Chang, et al.
Bupropion for smokers hospitalized with acute cardiovascular disease.
Am J Med, 119 (2006), pp. 1080-1087
[26.]
S. Parrot, C. Godfrey.
Economics of smoking cessation.
[27.]
C.A. Jiménez Ruiz, M. Mayayo, A. Cicero, N. Amor, J.J. Ruiz, M. Cristóbal, et al.
Resultados asistenciales de una unidad especializada en tabaquismo.
Arch Bronconeumol, 45 (2009), pp. 540-544
[28.]
I. Nerín, P. Novella, A. Beamonte, P. Gargallo, A. Jiménez-Muro, A. Marqueta.
Resultados del tratamiento del tabaquismo en una unidad especializada.
Arch Bronconeumol, 43 (2007), pp. 669-673
[29.]
P.R. Fung, S.L. Snape-Jenkinson, M.T. Godfrey, K.W. Love, P.V. Zimmerman, I.A. Yang, et al.
Effectiveness of hospital-based smoking cessation.
Chest, 128 (2005), pp. 216-223
Copyright © 2011. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?