Integrating smoking cessation into routine care in hospitals--a randomized controlled trial

D Thomas; M J Abramson; B Bonevski; S Taylor; S G Poole; E Paul; G R Weeks; M J Dooley; J George

doi:10.1111/add.13239

Integrating smoking cessation into routine care in hospitals--a randomized controlled trial

Addiction. 2016 Apr;111(4):714-23. doi: 10.1111/add.13239. Epub 2016 Jan 13.

Authors

D Thomas¹, M J Abramson², B Bonevski³, S Taylor⁴, S G Poole^{1

5}, E Paul^{2

6}, G R Weeks^{1

7}, M J Dooley^{1

5}, J George¹

Affiliations

¹ Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.
² Department of Epidemiology and Preventive Medicine, Monash University, The Alfred, Melbourne, Victoria, Australia.
³ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.
⁴ Pharmacy Department, Austin Health, Melbourne, Victoria, Australia.
⁵ Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.
⁶ Clinical Haematology Department, The Alfred, Melbourne, Victoria, Australia.
⁷ Pharmacy Department, Barwon Health, Geelong, Victoria, Australia.

PMID: 26597421
DOI: 10.1111/add.13239

Abstract

Aims: To evaluate the effectiveness of a pharmacist-led multi-component smoking cessation programme (GIVE UP FOR GOOD) compared with usual care in hospitalized smokers.

Design: Randomized, assessor-blinded, parallel-group trial.

Setting: Three tertiary public hospitals in Australia.

Participants: A total of 600 adult in-patient smokers [mean ± standard deviation (SD), age 51 ± 14 years; 64% male] available for 12 months follow-up.

Interventions: Multi-component hospital pharmacist-led behavioural counselling and/or pharmacotherapy provided during hospital stay, on discharge and 1 month post-discharge, with further support involving community health professionals (n = 300). Usual care comprised routine care provided by hospitals (n = 300).

Measurements: Two primary end-points were tested using intention-to-treat analysis: carbon monoxide (CO)-validated 1-month sustained abstinence at 6-month follow-up and verified 6-month sustained abstinence at 12-month follow-up. Smoking status and pharmacotherapy usage were assessed at baseline, discharge, 1, 6 and 12 months.

Findings: Sustained abstinence rates for intervention and control groups were not significantly different at both 6 months [11.6% (34 of 294) versus 12.6% (37 of 294); odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.55-1.50] and 12 months [11.6% (34 of 292) versus 11.2% (33 of 294); OR = 1.04, 95% CI = 0.63-1.73]. Secondary end-points, self-reported continuous abstinence at 6 and 12 months, also agreed with the primary end-points. Use of pharmacotherapy was higher in the intervention group, both during hospital stay [52.3% (157 of 300) versus 42.7% (128 of 300); P = 0.016] and after discharge [59.6% (174 of 292) versus 43.5% (128 of 294); P < 0.001].

Conclusions: A pharmacist-led multi-component smoking cessation intervention provided during hospital stay did not improve sustained abstinence rates at either 6 or 12 months compared with routine hospital care.

Keywords: Hospitals; pharmacists; randomized controlled trial; smoking cessation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Australia
Counseling*
Follow-Up Studies
Health Promotion / methods
Hospitals, Public
Humans
Inpatients*
Program Evaluation
Single-Blind Method
Smoking Cessation / statistics & numerical data*
Tertiary Care Centers
Tobacco Use Cessation Devices*
Tobacco Use Disorder / drug therapy
Tobacco Use Disorder / therapy*
Treatment Outcome