Of those hospitalized patients at Dankook University Hospital, this study examined the 280 adult smokers who had visited the smoking cessation clinic of the family medicine department in order to quit smoking from January 2013 to July 2014. This study defined the entire process from actual smoking cessation consultation and treatment to re-visiting an outpatient clinic as treatment compliance. Of those referred patients, the 145 patients were not registered due to the following reasons: (1) some of these patients had already been discharged from the hospital before the smoking cessation consultation began, (2) some of these patients had severe disease so that they could not proceed with the consultation, and (3) some of these patients had refused to participate in the smoking cessation consultation. During the period of this study, a treatment request response that recommended to prescribe varenicline was created for a total of the 135 patients after the smoking cessation consultation. However, only the 80 patients actually received the prescription by their respective doctor. That is, only the 80 patients began the medication. In regard to these 80 patients, this study conducted the retrospective phone survey at least 6 months after the smoking cessation consultation ended for the last registered patient from January to February 2015. During this period, the 15 patients could not be reached over the phone even though we had tried to contact them at 5 times. Moreover, the 8 patients had not completed the first visit time questionnaire properly. The 3 patients had died during this period. The 2 patients had refused to participate in the phone survey. Therefore, this study has examined the smoking cessation rate and drug compliance of the 52 patients (Figure 1).

This study is a retrospective observational study. That is, this study was based on the phone survey conducted for one month from January 2015 and the self-report type survey data of the initial phase. Of the 80 prescribed patients, this study targeted the 52 patients. This study asked these 52 patients about whether they had successfully quit smoking for 6 months after being discharged from the hospital. This study also asked these 52 patients about the side-effects of drugs, the compliance, and the reasons why they had failed to quit smoking. This study defined those who had successfully quit smoking for 6 months after being discharged from the hospital as the 'successful group' who successfully quit smoking. For the other patients, this study defined them as the 'failed group.' In regard to the 35 patients who had spent more than 12 months after their first consultation, an annual smoking cessation rate was calculated. Furthermore, this study aimed to identify the association with the preliminary variables based on the survey data such as the demographic characteristics and smoking history between the successful group and the failed group. In regard to the demographic characteristics such as age, educational level, and monthly income level, which would influence the drug compliance, this study referred to the contents of the aforementioned self-report type questionnaires created at the time of consultation. For those patients who could not complete the questionnaire due to their medical condition at the time of hospitalization, they were instructed to fill up the short version of questionnaire that contained only the depression selective questions and smoking cessation willingness score. A total of the 12 patients had filled up this short version of questionnaire.

The main variables used in this analysis are as follows. First, in regard to Fagerstrom's Test for Nicotine Dependence that assesses the nicotine dependence in the self-report questionnaire of patients, a score of less than 3 points was classified as 'low dependence,' whereas a score of 4 to 6 points was classified as 'medium dependence,' and a score of more than 7 points was classified as 'high dependence.'

In regard to the willingness of patients for quitting smoking, this study conducted 10-point Likert scale in the beginning of the program with the question on whether they could completely succeed to quit smoking with this opportunity. A score of 1 to 3 points was classified as 'low degree of willingness,' whereas a score of 4 to 6 points was classified as 'intermediate degree of willingness,' and a score of 7 to 10 points was 'high degree of willingness.'

The drug compliance must have been based on a period of 12 weeks. However, the patients had usually received their prescription once a month. Furthermore, it was difficult to confirm whether they were actually taking medicine at the time of completing the 12-week program. Hence, this study inevitably had to define those patients who had taken the medicine as the drug compliance group based on the visit of 8th week visit. Also, this study defined the patients who had been prescribed varenicline from the family medicine department or their respective outpatient clinic more than once after they were discharged from the hospital.

The hospitalized smoking cessation program of our hospital begins when relevant professors or attending physicians refer patients having agreed to quit smoking to the family medicine department among patients hospitalized at each clinical department. The list of referred patients is sent to the relevant professors of family medicine department. These patients will then be registered in the hospital computer system as a patient referred for smoking cessation. The patients who could move around freely were instructed to fill up a self-report questionnaire that contains the following questions after visiting the family medicine department: age, gender, educational level, monthly household income, marital status, weekly drinking quantity, weekly exercise frequency, nicotine dependence, willingness for quitting smoking, presence of depression, smoking period, smoking quantity (pack-year), clinical department for hospitalization, name of disease at the time of hospitalization, and past experience for quitting smoking. These patients were then instructed to undergo the breath carbon monoxide measurement (Micro CO; Micro Medical Ltd., Chatham, UK). The patients who were unable to move around freely were instructed to fill up a self-report questionnaire and undergo the carbon monoxide measurement in their hospital room after the relevant doctors of the family medicine department visited there. After conducting a one-on-one consultation with the patients based on the motivation elicitation theory, the doctors created a reply letter to recommend the patients to take the smoking cessation medicine during admission period, receive the additional prescription at the time of being discharged from the hospital, and make a reservation at the outpatient clinic of family medicine department.

Those patients who were suspected to suffer from depression or who were unable to proceed with oral administration were prescribed bupropion or nicotine patch. However, all of the other patients were prescribed varenicline. In the first week, they took 0.5 mg of varenicline. For the first 3 days, they took it once a day. For the next 4 days, they took it twice a day. Since then, they took 1 mg of varenicline twice a day. In regard to the prescription after discharge from the hospital, the patients were prescribed varenicline for 4 weeks unless there was an exceptional case. The average consultation time was about 20 to 40 minutes. No re-visit consultation was carried out unless there was an exceptional case.

As for the statistical analysis, this study first summarized the data in an Excel file and then analyzed the data by utilizing PASW SPSS ver. 18.0 (SPSS Inc., Chicago, IL, USA). In regard to the univariate analysis, this study performed chi-square and t-test with significance level of 0.05. This study set the variables having a statistically significant difference in the univariate analysis as an independent variable. Moreover, this study performed logistic regression analysis with success of quitting smoking in 6 months as a dependent variable.

Of the 280 patients referred during the period, the 256 patients were men (91.4%), whereas the 24 patients were women (8.6%). The ages ranged from 19 years old to 86 years old. The average age was 56.3±12.8 years old. The patients referred from the department of neurology accounted for the largest proportion with 60.4% (169 patients), followed by the department of cardiovascular medicine with 11.1% (31 patients), the department of gastroenterology with 5.4% (15 patients), and the department of orthopedics with 4.6% (13 patients).

Of the referred patients, the 190 patients received the consultation with the doctors of family medicine department. Sixty-seven point nine percent of the patients underwent the actual treatment based on their smoking cessation request. The 55 patients (19.6%) refused to have an interview, whereas the 23 patients (8.2%) were discharged from the hospital before the interview began. The 12 patients (4.3%) were in a condition that they were unable to proceed with an interview. Of the 12 patients who were unable to proceed with an interview, the 11 patients (91.7%) were hospitalized at the department of neurology. This study found no significant correlation between the refusal rate of interview, age, and hospitalization treatment of the patients.

Of the 190 patients who had an interview, the 135 patients (71.0%) were recommended to take varenicline, whereas the 42 patients (22.1%) had only an interview but were not prescribed any medicine. The 11 patients (3.9%) were recommended to take bupropion, whereas the 2 patients (0.7%) were recommended to take only nicotine patch. Of them, the 80 patients (59.3%) were actually prescribed varenicline, whereas the 6 patients (54.5%) were prescribed bupropion and the 1 patients (50.0%) was prescribed nicotine patch.

Of the 80 patients who were prescribed varenicline at the time of hospitalization, the 43 patients (53.7%) were additionally prescribed varenicline when they were discharged from the hospital. Of these 43 patients, only the 14 patients (32.5%) were additionally prescribed varenicline by revisiting the outpatient clinic of family medicine department (Figure 1).

Of the 52 subjects for the final analysis, the 50 patients were men (96.2%), whereas only the 2 patients were women (3.8%). The ages ranged from 19 years old to 78 years old. The average age was 52.1 years old. The 35 patients received the consultation in 2013, whereas the 17 patients received the consultation in 2014. The 30 patients were married people (75.0%). The patients with a high school diploma accounted for the largest proportion with 42.5% (17 patients). The patients whose monthly household income was between 3 million Korean won (KRW) and 10 million KRW accounted for the largest proportion with 45.9% (17 patients out of 37 patients), followed by those whose monthly household income was between 1 million KRW and 3 million KRW with 43.2% (16 patients).

In regard to the clinical department of patients, the department of neurology accounted for the largest proportion with 36.5% (19 patients), followed by the department of cardiology, the department of gastroenterology, the department of neurosurgery, and the department of orthopedics, all of which had the 5 patients (9.6%) each. In regard to the disease, the stroke patients accounted for the largest proportion with 38.5% (20 patients), followed by the patients with cardiovascular disease with 9.6% (5 patients: 2 patients with angina and 3 patients with myocardial ischemia) and the patients with a fracture with 5.8% (3 patients).

There were the 23 patients (44.2%) who had voluntarily visited the smoking cessation clinic, whereas there were the 12 patients (23.1%) who had visited the smoking cessation clinic at the recommendation of their attending physician. The 6 patients (11.5%) answered that they fell in both of the aforementioned cases. Of the 42 respondents, the 26 patients (61.9%) said that they had previously attempted to quit smoking. The average age of starting smoking was 20.5±4 years old. It ranged from 14 years old to 32 years old. The average total smoking period was 31.4±12 years. It ranged from 5 years to 60 years. The mean score of the nicotine dependence of the participants from the Fagerstrom questionnaire was 5.5±2 points (Table 1).

Of the 52 subjects who were prescribed varenicline, the 2 patients (3.8%) had never taken the medicine for a single day. Of the 52 patients who had taken the medicine for more than one day, the 9 patients (17.3%) had taken the medicine for more than 8 weeks, whereas the 7 patients (13.5%) had taken the medicine for more than 12 weeks. In regard to the reasons why they had stopped taking varenicline, the 13 patients (28.9%) stopped taking it because they thought that they could quit smoking on their own will, whereas the 10 patients (22.2%) stopped taking it because they had some side-effects. Also, the 8 patients (17.8%) stopped taking it because they were not prescribed additional varenicline during their respective treatment process. Of the 50 patients who had taken varenicline, a total of the 12 patients (24.0%) complained about the side-effects. Specifically, the 6 patients (12.0%) had nausea, whereas the 3 patients (6.0%) had dyspepsia. The 8 patients (66.7%) stopped suffering from the side-effects when they stopped taking the medicine.

Of the 52 patients, the 19 patients (36.5%) had stopped smoking for more than 6 months. This study confirmed that the 15 patients (42.8%) had stopped smoking for more than one year out of the 35 patients who had spent more than one year after the consultation.

In regard to each clinical department, the 11 patients (57.9%) out of the 19 patients hospitalized at the department of neurology have succeeded to quit smoking for 6 months. Among the 33 patients from all of the other departments, the 8 patients (24.2%) have succeeded to quit smoking. Hence, the success rate of smoking cessation of the patients hospitalized at the department of neurology was significantly higher (P=0.02). For each disease, the 11 patients (55.0%) out of the 20 stroke patients have succeeded to quit smoking, whereas the 8 patients (25.0%) out of the 32 patients with other diseases have succeeded to quit smoking. Hence, the success rate of smoking cessation of the stroke patients had a significantly higher success rate of smoking cessation (P=0.03).

There was no significant difference in the success rate of smoking cessation depending on the age, reason for visiting the smoking cessation clinic, nicotine dependence stated in the preliminary questionnaire, daily smoking quantity, willingness of smoking cessation, smoking period, and revisiting family medicine department of the patients. Of the 10 patients who had taken the medicine for a long time (more than 8 weeks), the 2 patients (20.0%) have succeeded to quit smoking for 6 months. Of the 42 patients who had taken within 8 weeks, the 17 patients (40.5%) have succeeded to quit smoking. However, there was no significant correlation (P>0.29).

Marital status was not significantly correlated to smoking cessation. However, the 11 patients (55.0%) of the 20 smokers whose monthly household income was more than 3 million KRW have succeeded to quit smoking, whereas only the 8 patients (25.0%) of the 32 smokers whose monthly household income was less than 3 million KRW have succeeded to quit smoking. Thus, the patients whose monthly household income was more than 3 million KRW had a significantly higher success rate of smoking cessation (P<0.03).

In regard to the physical change due to smoking cessation, no particular physical change accounted for the largest proportion with 57.9% (11 patients), followed by skin improvement with 26.3% (5 patients) and weight increase with 21.1% (4 patients) (Table 2).

This study conducted the logistic regression analysis with age, referring department, disease causing hospitalization, and personal wealth as an independent variable and success of smoking cessation for 6 months as a dependent variable. However, there was no significant correlation.