Factors associated with receipt of the 5As model of brief intervention for smoking cessation among hospitalized patients

Background and Aims Guidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self-reported receipt of the 5As (ask, advise, assess, assist and arrange). Design Multi-center cross-sectional study. Setting and participants Adult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014-2015. Measurements We explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A(0): no intervention; A(1): ask; A(2): ask and advise; A(3): A(2) and assess; A(4): A(3) and assist; and A(5): A(4) and arrange a follow-up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi-level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received. Findings A total of 60.4% (n = 624) of patients had been asked (A(1)) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A(2)), 26.6% (n = 48) assessed (A(3)) and 4.6% (n = 10) received all the components of the 5As (A(5)). Middle-aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69-7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11-4.34) were most likely to have been asked, advised and assessed (A(3)). The cessation intervention was most frequently performed by physicians. Conclusions In the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation.