JCAHO studying how hospitals help patients stop smoking

The Joint Commission on Accreditation of Healthcare Organizations has begun a study to examine the types of counseling hospitals offer patients to help them quit smoking. The goal of the study is to identify and evaluate strategies hospitals can use to help patients who smoke to kick the habit.

A survey was sent to 185 hospitals around the country asking them about their programs for smoking-cessation counseling for three types of patients: those suffering heart attack, heart failure, or pneumonia, said Karin Jay, senior researcher with the division of research at JCAHO. The questionnaire asks whether the institutions are identifying which of these classes of patients are smokers and, if they are smokers, what types of smoking-cessation counseling is being offered to them.

The initiative is being funded by a $25,000 grant from the Smoking Cessation Leadership Center at the University of California, San Francisco, which is in turn supported by the Robert Wood Johnson Foundation, said Jay. The hospitals chosen to receive the survey were not picked completely at random, since some institutions chosen were known to have good smoking-cessation practices in place, she said. Another 15 healthcare organizations volunteered for the survey after JCAHO sent out a press release about the study, she noted.

Identifying smokers and helping them quit is extremely important, said Fred Mayer, Pharm.D., M.P.H., president of Pharmacists Planning Service Inc. (PPSI). He stated that 423,000 Americans die each year from smoking-related diseases. Hospital pharmacists can play a major role in helping hospitalized patients quit smoking, he said, noting that, as an example, stroke patients are given medications and receive counseling from a pharmacist while they are hospitalized. "When better to give them the word about smoking cessation than at that time?" he asked.

Physicians can order a pharmacy consultation for all smoking patients, Mayer said. A hospital R.Ph. can sit down with patients and discuss their smoking habits and determine what type of antismoking programs or other therapies would be appropriate, he said. "We [at PPSI] train hospital pharmacists to counsel patients about smoking and set up a 'quit date,' " he said. A physician would prescribe the counseling, and the pharmacist would then receive a fee for the service, he added. The pharmacist would also follow up with the patient and give further counseling if needed.

Mayer spoke on eliminating tobacco from healthcare facilities at a meeting of the Federation Internationale Pharmaceutique (FIP) in New Orleans in September. FIP has issued a statement of policy, "The role of the pharmacist in promoting a tobacco-free future," and has created the Global Network of Pharmacists Against Tobacco.

A survey conducted by the smoking-cessation program at the University of California, San Francisco, two years ago found that there was an average of about three hours of antitobacco education given at American schools of pharmacy, said Karen Suchanek Hudmon, Dr. P.H., M.S., R.Ph. Hudmon, who is assistant professor of epidemiology in the Department of Epidemiology and Public Health at Yale University School of Medicine, was at UCSF until 2003. "We advocate a minimum of six hours," she said. A curriculum on smoking and smoking cessation-Rx for Change-created at UCSF, is now being used in U.S. schools of pharmacy, she said. By the end of 2004, 64 out of 89 schools of pharmacy will be using the program. This program addresses all pharmacists. "It can be applied to any practice setting," she said.

JCAHO's survey does not directly address the role of hospital R.Ph.s in smoking cessation, Jay said. It does ask what types of prescription drug support is offered to patients who smoke. "We would be thrilled to explore what the role of the hospital pharmacist could be," she said.