Chart reminders increase referrals for inpatient smoking cessation intervention

Time series evaluation of an intervention to increase statin tablet splitting by general practitioners

BACKGROUND

Tablet splitting, in which a higher-dose tablet is split to get 2 doses, reduces patients' drug costs. Statins can be split safely. General practitioners (GPs) may not direct their patients to split statins because of safety concerns or unawareness of costs. Medical chart inserts provide cost-effective education to physicians.

OBJECTIVE

The aim of this study was to assess whether providing GPs with statin-splitting chart inserts would increase splitting rates, and to identify predictors of splitting.

METHODS

In 2005 and 2006, we faxed a statin chart insert to British Columbia GPs with a request for a telephone interview. Consenting GPs were mailed 3 statin chart inserts and interviewed by phone (the intervention). In an interrupted time series, we compared monthly rates of statin-splitting prescriptions among intervention and nonintervention GPs before, during, and after the intervention. In multivariate logistic regressions accounting for patient clustering, predictors of splitting included physician and patient demographics and the specific statin prescribed.

RESULTS

Of 5051 GPs reached, 282 (6%) agreed to the intervention. Before the intervention, GPs' splitting rate was 2.6%; after intervention, GPs' splitting rate was 7.5%. The rate for the nonintervention GPs was 4.4%. Intervention GPs were 1.68 (95% CI, 1.12-2.53) times more likely to prescribe splitting after the intervention than were nonintervention GPs. Other predictors were a patient's female sex (odds ratio [OR] = 1.26; 95% CI, 1.18-1.34), lower patient income (OR = 1.33; 95% CI, 1.18-1.34), and a lack of drug insurance (OR = 1.89; 95% CI, 1.69-2.04).

CONCLUSIONS

An inexpensive intervention was effective in producing a sustained increase in GPs' splitting rate during 22 months of observed follow-up. Expanding statin-splitting education to all GPs might reduce prescription costs for many patients and payors.

An ethnographic study of tobacco control in hospital settings

BACKGROUND

Tobacco control in hospital settings is characterised by a focus on protection strategies and an increasing expectation that health practitioners provide cessation support to patients. While practitioners claim to have positive attitudes toward supporting patient cessation efforts, missed opportunities are the practice norm.

OBJECTIVE

To study hospital workplace culture relevant to tobacco use and control as part of a mixed-methods research project that investigated hospital-based registered nurses' integration of cessation interventions.

DESIGN

The study was conducted at two hospitals situated in British Columbia, Canada. Data collection included 135 hours of field work including observations of ward activities and designated smoking areas, 85 unstructured conversations with nurses, and the collection of patient-care documents on 16 adult in-patient wards.

RESULTS

The findings demonstrate that protection strategies (for example, smoking restrictions) were relatively well integrated into organisational culture and practice activities but the same was not true for cessation strategies. An analysis of resources and documentation relevant to tobacco revealed an absence of support for addressing tobacco use and cessation. Nurses framed patients' tobacco use as a relational issue, a risk to patient safety, and a burden. Furthermore, conversations revealed that nurses tended to possess only a vague awareness of nicotine dependence.

CONCLUSION

Overcoming challenges to extending tobacco control within hospitals could be enhanced by emphasising the value of addressing patients' tobacco use, raising awareness of nicotine dependence, and improving the availability of resources to address addiction issues.

Attitudes Toward Giving Smoking Cessation Advice Among Nursing Staff at a Long-Term Residential Care Facility

The objective of this study was to provide a first assessment of (a) long-term care staffs' prevalence of and attitudes toward giving smoking cessation advice to residents and (b) predictors of advice giving. Results of a survey (N = 115) found that 54.8% of licensed nurses and 34.6% of nursing assistants reported ever advising. Advising was associated with job classification and believing that residents' problem lists should include smoking. Not advising was associated with believing advice is the physicians' responsibility. Staff somewhat endorsed risks of smoking and benefits of cessation for residents, smoking as a right and pleasure, and that some residents cannot make decisions about smoking. Staff moderately endorsed safety concerns: 36% wanted policy changes. Lack of institutional support and perceived residents' cessation disinterest were key barriers. The findings suggest that staff may be missing intervention opportunities and that institutional support of advising cessation may facilitate maintenance and improvement of nursing home residents' health.

Nursing and tobacco reduction: a review of the literature

Nurses have an instrumental role to play in tobacco reduction, which is one strategy used to address tobacco use; a primary source of preventable morbidity and mortality globally. The following review addresses activities by two groups of nurses: nursing governance bodies and nurse scientists, whom together provide vision and knowledge to support and shape nursing practice. While nursing governance bodies and scientists have contributed a great deal to tobacco reduction, there are also gaps. Areas that require strengthening are: support for tobacco dependent nurses, basic nursing education concerning tobacco dependency treatment, and integration of tobacco dependence treatment into nursing practice.

Assessing the feasibility of a clinical practice guideline for inpatient smoking cessation intervention

Although a great deal of effort has been devoted to the development of evidence-based practice guidelines at both the national and local levels, relatively few studies have explored translating these guidelines into clinical practice. The purpose of this study was to assess the feasibility of implementing an inpatient smoking cessation intervention, based on an externally developed clinical practice guideline, at a tertiary care medical center. All smokers who were referred to cardiac rehabilitation services for a 5-week period were eligible for referral to the smoking cessation program. Twenty patients participated in the bedside counseling program. The mean amount of time to deliver the intervention was 43.5 minutes. At 1 month, 14 (70%) of the participants reported continuous abstinence from tobacco. Estimated cost per patient for smoking cessation intervention was $51.14.