Systematic Identification and Treatment of Smokers by Hospital Based Cessation Practitioners in a Secondary Care Setting: Cluster Randomised Controlled Trial

Overview

Journal BMJ

Specialty General Medicine

Date 2013 Jul 10

PMID 23836616

Citations 18

Authors

R L Murray

J Leonardi-Bee

J Marsh

L Jayes

J Li

S Parrott

J Britton

Affiliations

Soon will be listed here.

Abstract

Objectives: To investigate the effectiveness of the systematic default provision of smoking cessation support to all adult smokers admitted to hospital, relative to usual care.

Design: Open, cluster randomised controlled trial.

Setting: Acute medical wards in one large teaching hospital in the United Kingdom.

Participants: 264 patients randomised to intervention and 229 to usual care; primary outcome data were available at four weeks for 260 and 224 patients, respectively. All adult smokers and recent ex-smokers able to give informed consent were eligible for entry into the study.

Interventions: The intervention comprised systematic smoking ascertainment and default provision of behavioural support and cessation pharmacotherapy for the duration of the hospital stay for all smokers and recent ex-smokers, with follow-up and referral to community services after discharge. Usual care comprised cessation support delivered at the initiative and discretion of clinical staff. All staff and patients were aware of group assignment.

Main Outcome Measures: Smoking cessation at four weeks, validated by measuring exhaled carbon monoxide. Secondary outcomes were uptake of inpatient behavioural support, use of cessation pharmacotherapy, referral to and uptake of community support after discharge, and validated smoking cessation at six months. Participants lost to follow-up were assumed to have reverted to smoking.

Results: All patients in the intervention group received at least brief advice to quit smoking, compared to 106 (46%) patients in the usual care group. Cessation at four weeks was achieved by 38% (n=98) of intervention patients and 17% (n=37) of usual care patients (adjusted odds ratio 2.10 (95% confidence interval 0.96 to 4.61), P=0.06, number of patients needed to treat 8). Uptake of inpatient behavioural support, use of pharmacotherapy, and referral to and uptake of community support after discharge were all substantially and statistically significantly higher in the intervention group than in the usual care group. Cessation at six months was achieved by 19% (n=47) of intervention and 9% (n=19) of usual care patients, although this difference was not significant (adjusted odds ratio 1.53 (95% confidence interval 0.60 to 3.91); P=0.37).

Conclusions: Substantial improvements in smoking cessation among smokers admitted to hospital can be achieved by systematic ascertainment and delivery of cessation support in secondary care.

Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN25441641.

Citing Articles

Interventions for smoking cessation in hospitalised patients.

Streck J, Rigotti N, Livingstone-Banks J, Tindle H, Clair C, Munafo M Cochrane Database Syst Rev. 2024; 5:CD001837.

PMID: 38770804 PMC: 11106804. DOI: 10.1002/14651858.CD001837.pub4.

Evaluation of a hospital-initiated tobacco dependence treatment service: uptake, smoking cessation, readmission and mortality.

Robins J, Patel I, McNeill A, Moxham J, Woodhouse A, Absalom G BMC Med. 2024; 22(1):139.

PMID: 38528543 PMC: 10964535. DOI: 10.1186/s12916-024-03353-8.

'The dark before the dawn': the 2021 British Thoracic Society Audit of the treatment of tobacco dependency in acute trusts.

Devani N, Mangera Z, Smith H, Gates J, Woodhouse A, Fullerton D BMJ Open Respir Res. 2023; 10(1).

PMID: 38030263 PMC: 10689366. DOI: 10.1136/bmjresp-2022-001532.

Successes and Challenges of Implementing Tobacco Dependency Treatment in Health Care Institutions in England.

Agrawal S, Mangera Z, Murray R, Howle F, Evison M Curr Oncol. 2022; 29(5):3738-3747.

PMID: 35621689 PMC: 9139257. DOI: 10.3390/curroncol29050299.

Cessation classification likelihood increases with higher expired-air carbon monoxide cutoffs: a meta-analysis.

Karelitz J, McClure E, Wolford-Clevenger C, Pacek L, Cropsey K Drug Alcohol Depend. 2021; 221:108570.

PMID: 33592559 PMC: 8026538. DOI: 10.1016/j.drugalcdep.2021.108570.

References

Parrott S, Godfrey C, Raw M, West R, McNeill A . Guidance for commissioners on the cost effectiveness of smoking cessation interventions. Thorax. 1999; 53 Suppl 5 Pt 2:S1-38. PMC: 1765918. View

Murray R, Leonardi-Bee J, Marsh J, Jayes L, Britton J . Smoking status ascertainment and interventions in acute medical patients. Clin Med (Lond). 2012; 12(1):59-62. PMC: 4953423. DOI: 10.7861/clinmedicine.12-1-59. View

Warner K . The Framework Convention on Tobacco Control: opportunities and issues. Salud Publica Mex. 2008; 50 Suppl 3:S283-91. DOI: 10.1590/s0036-36342008000900004. View

Doll R, Peto R, Boreham J, Sutherland I . Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004; 328(7455):1519. PMC: 437139. DOI: 10.1136/bmj.38142.554479.AE. View

Freund M, Campbell E, Paul C, McElduff P, Walsh R, Sakrouge R . Smoking care provision in hospitals: a review of prevalence. Nicotine Tob Res. 2008; 10(5):757-74. DOI: 10.1080/14622200802027131. View

Vega S, Stolare I . Smoking cessation education increases interventions in a New Zealand hospital: World No Tobacco Day revisited. N Z Med J. 2010; 123(1317):35-40. View

Rigotti N, Arnsten J, McKool K, Singer D, Pasternak R . The use of nicotine-replacement therapy by hospitalized smokers. Am J Prev Med. 1999; 17(4):255-9. DOI: 10.1016/s0749-3797(99)00095-1. View

Rigotti N, Clair C, Munafo M, Stead L . Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2012; (5):CD001837. PMC: 4498489. DOI: 10.1002/14651858.CD001837.pub3. View

Tengs T, Adams M, Pliskin J, Safran D, Siegel J, Weinstein M . Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal. 1995; 15(3):369-90. DOI: 10.1111/j.1539-6924.1995.tb00330.x. View

10.

Raw M, McNeill A, West R . Smoking cessation guidelines for health professionals. A guide to effective smoking cessation interventions for the health care system. Health Education Authority. Thorax. 1999; 53 Suppl 5 Pt 1:S1-19. PMC: 1765919. DOI: 10.1136/thx.53.2008.s1. View

11.

Lewis K, Durgan L, Edwards V, Dixon H, Whitehead C, Sykes R . Can smokers switch from a hospital-based to a community-based stop smoking service? an open-label, randomized trial comparing three referral schemes. Nicotine Tob Res. 2009; 11(6):756-64. DOI: 10.1093/ntr/ntp061. View

12.

Warner D, Sarr M, Offord K, Dale L . Anesthesiologists, general surgeons, and tobacco interventions in the perioperative period. Anesth Analg. 2004; 99(6):1766-1773. DOI: 10.1213/01.ANE.0000136773.40216.87. View

13.

May F, Stocks N, Barton C . Identification of barriers that impede the implementation of nicotine replacement therapy in the acute cardiac care setting. Eur J Cardiovasc Prev Rehabil. 2008; 15(6):646-50. DOI: 10.1097/HJR.0b013e3283101075. View

14.

West R, Hajek P, Stead L, Stapleton J . Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. 2005; 100(3):299-303. DOI: 10.1111/j.1360-0443.2004.00995.x. View

15.

Thy T, Boker T, Gallefoss F, Bakke P . Hospital doctors' attitudes toward giving their patients smoking cessation help. Clin Respir J. 2010; 1(1):30-6. DOI: 10.1111/j.1752-699X.2007.00005.x. View

16.

Vaughn T, Ward M, Doebbeling B, Uden-Holman T, Clarke W, Woolson R . Organizational and provider characteristics fostering smoking cessation practice guideline adherence: an empirical look. J Ambul Care Manage. 2002; 25(2):17-31. DOI: 10.1097/00004479-200204000-00004. View

17.

Hajek P, Taylor T, Mills P . Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial. BMJ. 2002; 324(7329):87-9. PMC: 64504. DOI: 10.1136/bmj.324.7329.87. View

18.

Molyneux A, Lewis S, Leivers U, Anderton A, Antoniak M, Brackenridge A . Clinical trial comparing nicotine replacement therapy (NRT) plus brief counselling, brief counselling alone, and minimal intervention on smoking cessation in hospital inpatients. Thorax. 2003; 58(6):484-8. PMC: 1746718. DOI: 10.1136/thorax.58.6.484. View

19.

Hawkshaw B, Zuo Y . Audit of prescribed nicotine replacement therapy to hospital inpatients who smoke. Med J Aust. 2005; 182(1):43-4. DOI: 10.5694/j.1326-5377.2005.tb06557.x. View

20.

Goldstein M . Missed opportunities to assist hospitalized smokers. Am J Prev Med. 1999; 17(4):317-8. DOI: 10.1016/s0749-3797(99)00096-3. View