Patient and Physician Perspectives on Treating Tobacco Dependence in Hospitalized Smokers With Substance Use Disorders: A Mixed Methods Study
Autor: | Minda Gowarty, Zoe M. Weinstein, V. Cobb, Eric D. Helm, Ryan G. Seibert, Renda Soylemez Wiener, Hasmeena Kathuria |
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Rok vydání: | 2019 |
Předmět: |
Adult
Counseling Male medicine.medical_specialty Health Knowledge Attitudes Practice Substance-Related Disorders medicine.medical_treatment media_common.quotation_subject MEDLINE Context (language use) Interviews as Topic New England Physicians medicine Humans Pharmacology (medical) Qualitative Research Nicotine replacement media_common Tobacco Use Cessation business.industry Addiction Smoking Middle Aged medicine.disease Combined Modality Therapy Tobacco Use Cessation Devices Substance abuse Hospitalization Psychiatry and Mental health Addiction medicine Family medicine Smoking cessation Female business Qualitative research |
Zdroj: | Journal of addiction medicine. 13(5) |
ISSN: | 1935-3227 |
Popis: | Objective Individuals with substance use disorders have a high prevalence of smoking cigarettes. Hospitalization represents an opportunity to deliver concurrent treatment for tobacco and other substances. Using a sequential explanatory mixed methods design, we characterized practices and perspectives of patients and physicians about smoking cessation counseling during inpatient addiction medicine consultations. Methods We abstracted data from 694 consecutive inpatient addiction consult notes to quantify how often physicians addressed tobacco dependence using the guideline-recommended 5As framework. We conducted semi-structured interviews with 9 addiction medicine physicians and 20 hospitalized smokers with substance use disorders. We analyzed transcripts to explore physicians' and patients' perspectives on smoking cessation conversations during inpatient addiction consultations, physician-perceived barriers and facilitators to engaging inpatients in tobacco treatment, and strategies to improve tobacco treatment in this context. Results 75.5% (522/694) of hospitalized substance use disorder patients were current smokers. Among smokers, 20.9% (109/522) were offered nicotine replacement while hospitalized, but only 5.4% (28/522) received the full guideline-recommended 5As. Patients and physicians reported minimal discussion about tobacco addiction during hospitalization. Physicians cited tobacco not being an immediate health threat and the perception that quitting tobacco is not a priority to patients as barriers, often limiting thorough counseling to patients with smoking-related admissions. Physicians and patients offered strategies to integrate treatment of tobacco dependence and other substances. Conclusions Inpatient addiction consultations represent a missed opportunity to counsel patients with substance use disorders to quit smoking. System-level changes are needed to coordinate treatment of tobacco and other drug dependence in hospitalized smokers. |
Databáze: | OpenAIRE |
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