Smoking cessation interventions for in‐patients: a selective review with recommendations for hospital‐based health professionals

Abstract

A selective review of the literature was conducted to provide evidence-based recommendations for the clinical management of hospitalized smokers. The Cochrane library, in particular the Cochrane review of 'Interventions for smoking cessation in hospitalised patients', was the basis for the review and was supplemented with other clinical and non-clinical literature where the review did not inform clinicians sufficiently. Evidence was reviewed on issues considered by the authors to be of importance to health professionals interested in providing a smoking cessation intervention to their patients. The review suggests that effective hospital interventions: incorporate an in-patient intervention lasting greater than 20 minutes in duration with extended post discharge follow-up; consist of at least five intervention contacts; and be delivered over at least a 3-month period. Furthermore, interventions should include in-patient advice and counselling, the provision of nicotine replacement therapy and extended proactive post discharge telephone support. The review also indicates that cessation interventions are particularly effective when delivered to patients with a cardiovascular diagnosis. All health professionals may be effective in providing cessation treatments; however, the addition of a specialist smoking cessation counsellor appears to improve interventions in this setting. Finally, without the development of supportive systems, routine intervention with smoking patients by health professionals is unlikely. Recommendations for the delivery of effective smoking cessation interventions in hospitals are provided. [Wolfenden L, Campbell E, Walsh RA, Wiggers J. Smoking cessation interventions for in-patients: a selective review with recommendations for hospital-based health professionals.

A programme for reducing smoking in pre‐operative surgical patients: randomised controlled trial*

“…Previous work by the authors describes the need for multicomponent interventions in hospital settings [28]. The current study has found that the annual cost of delivering such interventional components to dependent smokers was approximately £5869, or £154 per incremental patient abstinent at the 3-month follow-up.…”

Tabagismo em pacientes internados em um hospital universitário

“…Post-discharge support, which should be individualized and prolonged, with or without the use of medications, is essential for treatment success. (25) Simply prohibiting smoking in the hospital environment is an insufficient intervention for these patients. At the HUAP, physicians refer all smoking outpatients to experts in smoking cessation, regardless of the nature of the underlying disease.…”

Feasibility, acceptability, and cost of referring surgical patients for postdischarge cessation support from a quitline

“…Research suggests that smoking cessation interventions delivered only during the inpatient period do not significantly increase long-term quit rates, because they fail to provide the necessary ongoing support to address the high rate of relapse after discharge (Rigotti, Munafò, Murphy, & Stead, 2002;Warner, Patten, Ames, Offord, & Schroeder, 2004;Wolfenden, Campbell, Walsh, & Wiggers, 2003). Whereas a variety of methods are available to hospitals to provide postdischarge smoking cessation support to smokers, those relying on patient initiation or attendance, such as access to telephone counseling services or referral to group-based treatment, fail to reach the majority of smokers (Ockene et al, 1992;Winickoff, Buckley, Palfrey, Perrin, & Rigotti, 2003;Winickoff, Hillis, Palfrey, Perrin, & Rigotti, 2003).…”