Mathilde ROCHE

Marion ADLER

André RIEUTORD

An integrated care model based on a smoking cessation programme was designed to assist smoking patients to quit tobacco. Pharmacy and addictology departments co-built and led the project. It was implemented and proposed to patients from May 2018 in three medical and surgical wards.

Many smoking patients are not identified as smokers when admitted at the hospital, depriving them of any help to quit smoking. During medication reconciliation at admission (MR), the pharmacist is in a position to identify smoking patients and then offer a support programme.

The project included five steps: 1. Training of one clinical pharmacist about smoking cessation by the addictology team. 2. Designing the process and developing tools used for a smoking cessation programme. 3. Implementing the programme. 4. Evaluating the pilot phase. 5. Developing a comprehensive training programme (including role-play sessions) for the pharmaceutical team. The process counted six steps: 1. Smoking patients’ identification (MR, patient record, request from doctors). If the patient was polyaddicted, the addictology team was informed. 2. First patient visit: patient consent was collected, anamnesis related to tobacco and explanation about nicotine’s mechanisms and nicotine substitutes given. Appropriate nicotine substitutes were selected and tested with the patient. 3. Prescription and administration of nicotine substitutes. 4. Second patient visit (24 to 48 hours’ later): nicotine substitutes adjusted if needed. 5. Third patient visit if needed. 6. Discharge medication reconciliation.

During 4 months, 62 patients were identified as smokers during MR interviews. Twenty-seven per cent of the patients (n= 17) were sent to the addictology team because of polyaddiction, 39% (n=24) refused the programme and 34% (n=21) accepted to experience our support programme. Of these, 62% (n=13) either reduced or quit smoking during hospitalisation.

According to our encouraging preliminary results, this programme will continue to be carried on by the pharmaceutical team, while keeping a close link with the addictology team. We decided to call the patients one week and one month after discharge to better assess the performance of our smoking cessation programme.