Effectiveness of a Cognitive Orientation Program With and Without Nicotine Replacement Therapy in Stopping Smoking in Hospitalised Patients

IntroductionWe have analyzed the effectiveness of high-intensity cognitive-behavioral intervention initiated during hospitalization, compared with minimal intervention. We have also analyzed whether the combination of intervention with nicotine replacement therapy (NRT) can increase smoking abstinence rates after 12 months of follow-up.MethodsWe studied 2,560 active smokers during their hospital stays. Of these, 717 smokers declined to participate in the study, and after minimal intervention they were asked for permission to telephone them one year later to ask if they continued to smoke. The remaining 1,843 smokers received high-intensity cognitive therapy and were randomized to receive NRT or not. The follow-up after hospital discharge was completed either in the outpatient consultation or by telephone sessions.ResultsOne year later, 7% of the patients who declined to participate in the study maintained smoking abstinence, compared with 27% of those who did participate in the study (p<0.001). There were significant differences between the group that only received behavioral treatment (21% abstinence) compared with the group that also received NRT (33% abstinence; p = 0.002). In this last group, there were significant differences (p = 0.03) between those who attended outpatient consultation (39% abstinence) and those who had telephone sessions (30%). In the multivariate analysis, the predictors for abstinence 12 months later were: having used NRT (OR 12.2; 95% CI, 5.2-32; p = 0.002) and a higher score on the Richmond test (OR 10.1; 95% CI, 3.9-24.2; p = 0.01).ConclusionsCognitive orientation interventions initiated in hospitalized smokers increase 12-month abstinence rates compared with minimal intervention, and said rates increase significantly when NRT is added.

ResumenIntroducciónAnalizamos la eficacia de una intervención conductual-cognitiva de alta intensidad frente a una intervención mínima iniciada durante un ingreso hospitalario, y si la combinación con tratamiento sustitutivo con nicotina (TSN) puede aumentar las tasas de abstinencia a los 12 meses de seguimiento.MétodoSe estudiaron 2.560 fumadores activos durante un ingreso hospitalario. De ellos, 717 fumadores rehusaron entrar en el estudio y tras una intervención mínima se les solicitaba poder telefonearlos al año para preguntar si continuaban fumando. El resto, 1.843 fumadores recibieron tratamiento cognitivo de alta intensidad y fueron aleatorizados para recibir o no TSN. El seguimiento tras el alta se realizaba en consultas externas o con sesiones telefónicas.ResultadosAl año de seguimiento, el 7% de los que rehusaron entrar en el estudio se mantenían sin fumar frente al 27% de los que entraron en el estudio (p < 0,001). Existían diferencias significativas entre el grupo que realizó solo tratamiento conductual (21% de abstinencia) frente al grupo que además realizó TSN (33% de abstinencia; p = 0,002). En este último grupo existían diferencias significativas (p = 0,03) entre los que realizaron el seguimiento en consultas (39% de abstinencia) frente a los que hicieron el control telefónico (30%). En el análisis multivariante, los predictores de abstinencia a los 12 meses fueron: haber utilizado TSN (OR 12,2; 95% de CI, 5,2–32; p = 0,002) y mayor puntuación en el test de Richmond (OR 10,1; 95% de CI, 3,9–24,2; p = 0,01).ConclusionesUna intervención de orientación cognitiva iniciada en fumadores ingresados aumenta las tasas de abstinencia a los 12 meses frente a una intervención mínima, y aún aumenta de forma más significativa dichas tasas si se le añade TSN.