Integrating Tobacco Dependence Treatment into Hospital Practice Using the Rochester Model

Abstract

Purpose

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

Abbreviations

RM, Rochester Model; TTS, Tobacco Treatment Specialist; RT, Respiratory Therapist; MS, Medical student; UR, University of Rochester; IVR, interactive voice response; NCC, nurse call counselor, AT, as treated, ITT, intent-to-treat.

Acknowledgments

The authors would like to thank Dr. Kimberly P. Richter PhD, MPH from the University of Kansas for her helpful comments.

Disclosure

The authors declare that they have no competing interests in this work.