After a hospital stay, a transition to stop smoking


Chronic medical conditions can result in repeat hospital stays that frustrate individuals, as well as the physicians who care for them. Whether someone has diabetes, heart failure, chronic obstructive pulmonary disease (COPD) or kidney disease, Emerson’s goal is to send the patient home to get better — not land back in the hospital. A state-funded program launched last year is helping Emerson achieve success.

The hospital is taking a two-pronged approach. First, when someone is admitted to Emerson and determined to be at high risk for readmission because of their diagnosis or health history, they will likely receive a visit from Meagan Coughlin, PharmD, a pharmacist.

“We review everything related to the medications they are taking,” she explains. “That includes what their primary care physician has in their medical record and what medications their local pharmacy has listed for them.

“I always ask patients ‘why are you taking that?’ and if they don’t know, we discuss it,” says Dr. Coughlin. The goal is for them to leave Emerson with a “clean” medication list, which improves care and helps reduce the chance they will be readmitted.

According to Robert Pacl, LCSW, a care transitions social worker from Minuteman Senior Services who is based at Emerson, many patients discover that maintaining good health comes down to two words: behavior change. His work with Emerson patients represents the other prong in the hospital’s efforts to reduce unnecessary readmissions.

“Most people know what they need to do — lose weight, watch their fluids, monitor their blood sugar, exercise or manage their emotions,” says Mr. Pacl. “How do we motivate someone to make an important behavior change? As a mental health clinician, I sometimes try to create discomfort with the status quo and see if they are ready to make a change.”

The right motivation leads to success

Juanda Sloan was ready, but it took some counseling from Mr. Pacl for her to see it. He and Dr. Coughlin, the pharmacist, had already impressed her several months prior, when she was admitted to Emerson and diagnosed with COPD. “Both Bob and Dr. Barkin asked me about my smoking,” Ms. Sloan recalls, referring to Peter Barkin, MD, an Emerson pulmonologist. “I’d been smoking since I was a teenager.”

Ms. Sloan prepared to head home with a prescription for a new inhaler — one that would be effective for the COPD, as well as her long-standing asthma. “I mentioned how expensive the inhaler is, and they found a discount program that saved me a substantial amount of money,” she says. “I appreciated that.”

Three months later, the Ayer resident was back in Emerson with shortness of breath. This time, Mr. Pacl decided to find the motivation that would convince Ms. Sloan to quit smoking. “Juanda told me she needed to stabilize her health so that she could continue working until her retirement at the end of the year,” he says. “Beyond that, she is planning to attend her family reunion in Barbados in 2017.”

“My family was worried about my health,” says Ms. Sloan, adding that she knew quitting smoking would make a difference. “I started thinking about what it costs to smoke: $10 a pack, and I smoked three or four packs a week. I could be saving that money.”

There were good reasons to quit: her health, her family’s concern and the cost of cigarettes, which would help cover her airfare to Barbados. Mr. Pacl proceeded to use cognitive behavioral therapy techniques to help Ms. Sloan redefine herself as a non-smoker. Today she has a cigarette only rarely.

“I thought about what Bob said. I knew quitting was in my best interest. Not long ago, someone offered to buy me a pack. I said no.”

She sees the benefits. “I don’t cough anymore, I am rarely short of breath, and my oxygen level is usually in the 90s, which is very good,” she notes.

Mr. Pacl has an impressive track record in helping Emerson patients to quit smoking. “The hospital is a good setting in which to highlight opportunities for people to change behavior and get healthy,” he says. “I’m catching people at an opportune moment.”