Background: Tobacco cessation is the most effective intervention for reducing the progression of disease in COPD patients and reducing mortality. Varenicline is the most effective drug to treat tobacco use disorder. The American Thoracic Society strongly recommends initiation of Varenicline for smoking cessation, even in patients who are not ready to quit. Hospitalist initiation of Varenicline takes advantage of the hospitalized patient’s forced abstinence from tobacco use, provides an opportunity for counseling on Varenicline’s safety and efficacy, and decreases the barriers to initiation.
Methods: This three-site quality initiative was a collaboration between the Pulmonary Division and the Division of Hospital Medicine. The pulmonary division generated a daily EPIC list of patients admitted with COPD with active tobacco use and notified the hospitalist teams. Hospitalists led house staff and advanced practice practitioners in conducting Varenicline counseling and initiation via an opt-out approach with the messaging “I’m going to give you a medicine that will change your relationship with nicotine.” Patients were discharged on Varenicline and referred to smoking cessation clinic. After discharge, data was collected on smoking reduction and quit rates via chart review and phone calls.
Results: 70 inpatients were prescribed Varenicline between August 2022 and September 2023. Of the 60 patients for which there was data at six months, 21.7% had quit and 26.7% were smoking less. Of the 63 patients that were discharged with a prescription for Varenicline, 36% had quit at 6 months and 32% were smoking less. This compares favorably to self-reported tobacco abstinence at twelve months post hospital discharge, which has been noted to be 16%.
Conclusions: Hospitalist initiation of Varenicline for COPD patients is effective for smoking cessation and improving the health and mortality of COPD patients. As opposed to the traditional stages of change behavioral model, this opt-out approach allows for more patients to be started on Varenicline and leads to higher quit and reduction rates. While impersonal automated interventions have not shown much benefit in smoking cessation, this intervention takes advantage of the inpatient relationship with the hospitalist team. Future expansion of this project will be to additional sites as well as to non-COPD patients that could most benefit from smoking cessation, such as cardiac patients.