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
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
392
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)
Quit SA 5A counselling over the phone. Maximum 8 calls over a 3 month period
Royal Adelaide Hospital
Adelaide, South Australia, Australia
The Queen Elizabeth Hospital
Adelaide, South Australia, Australia
Lyell McEwin Health Service
Adelaide, South Australia, Australia
Smoking abstinence
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.
Time frame: one year
Reduced hospital bed utilisation
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.
Time frame: one year
7-day point prevalence
Defined as no cigarettes for the previous 7 days
Time frame: from 2 weeks to 3 months post enrollment
Reduction in health care costs
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.
Time frame: one year
Inpatient craving levels
Craving scales will be used to assess levels during inpatient stay (pre and post intervention delivery)
Time frame: baseline to end of inpatient stay
Prevalence of inpatient smoking
Measured by self-report and observation by hospital and study staff prior to discharge.
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Time frame: From baseline to end of inpatient stay