Systematic delivery of a smoking cessation intervention after discharge from a secondary care setting

Abstract

Background Hospital admission provides an ideal opportunity to promote smoking cessation. Clinical guidelines recommend delivery of cessation interventions for all admissions but no research to date has focused on supporting smokers who successfully abstain from smoking whilst in hospital to maintain abstinence after discharge. We therefore designed a trial to test the effectiveness of an intensive home support intervention to maintain abstinence from smoking for newly abstinent smokers leaving hospital Methods Participants were recruited from 18 medical wards in one large teaching hospital in the UK and were individually randomised to either intervention or usual care using concealed allocation. During inpatient stay both treatment groups received smoking cessation support as recommended in NICE PH48 guidance. At discharge, patients randomised to usual care were offered a referral to a community Stop Smoking Service (SSS). Patients randomised to the intervention group were offered a home visit (or telephone call if a home visit is refused), as soon as practicable after discharge and typically within 48 hours, to deliver a multi-component intervention which included personalised behavioural support and nicotine replacement therapies (NRT). All smokers were asked to give consent to be contacted at four-weeks and three-months after discharge to assess smoking status and use of cessation support. Results 404 patients were randomised in total. 200 to intervention and 204 to usual care. Primary outcome data were available at four-weeks for 149 and 134 patients, respectively. Preliminary results demonstrate no statistically significant difference in quit rates between treatment groups at either 4 (21.00% intervention, 19.12% usual care) or 12 weeks (19.50% Intervention and 16.18% Usual Care) following discharge. Conclusions Adding a home visit to deliver additional smoking cessation support to patients who have remained abstinent during their hospital stay and treated according to NICE PH48 guidance does not increase quit rates