UCSF

Every year, millions of people who smoke are hospitalized and a large percentage of them would like to quit. Despite the fact that an acute hospitalization provides an important opportunity to engage patients who smoke in effective evidenced-based tobacco treatment interventions, most hospitals do not offer this type of coordinated tobacco treatment for hospitalized smokers. The purpose of this study was to explore and describe the institutional factors that facilitate or inhibit successful implementation of evidenced based tobacco treatment programs in hospitalized settings. The specific aims were to: identify the organizational processes involved in managing and implementing these programs and explore how people working within these programs conduct their routine operations, evaluate the effectiveness of the program, and measure patient outcomes. Institutional ethnography guided the study conduct and hermeneutic phenomenology guided the data analysis. Data were collected via interviews with thirty three individuals involved in tobacco dependence treatment programs in hospital organizations known to have excellent programs. Study results included: structural, cultural and operational barriers to care delivery, e.g. temporal constraints, patient stigmatization, and excessive demand for services, the impact of smoke free campus policies on care delivery and how it changed the emphasis of care from cessation to withdrawal management, and the influence of the Joint Commission core measure mandate on resource allocation and the difficulty in providing care or follow-up after hospital discharge. These findings suggest a need for new ways of conceptualizing tobacco dependence care delivery in hospital settings that accounts for these barriers. A hospitalization has the potential be a positive influence in these patients' lives, but in order to effectively treat and care for hospitalized smokers, organizations must identify them, approach them with empathy, and ensure evidenced based interventions and sound follow-up care are provided.