Evidence
There is strong evidence that secondary care represents a unique teachable moment when a smoker is admitted to hospital to seed the concept of a quit attempt and achieve successful long term abstinence. Data from Canada has demonstrated that comprehensive secondary care treatment programmes for tobacco addiction deliver immediate and highly significant reductions in admission rates and mortality.
The Ottawa Model for Smoking Cessation
A Canadian project called the “Ottawa Model for Smoking Cessation” has demonstrated significant and immediate benefits from implementing a comprehensive secondary care smoking cessation programme. This programme initially launched in 9 hospitals in Ottawa, increasing to 35 hospitals over time. The Ottawa team have published the outcomes in the intervention group across 14 hospitals in the months following implementation compared to a control group in the months leading up to implementation as follows:
The Ottawa Model of Smoking Cessation (OMSC) tested the effectiveness of a hospital-initiated smoking cessation programme across 14 hospitals in Canada. The core components of this model were: the systematic identification and documentation of all smokers admitted to hospital, the systematic administration of pharmacotherapy & behavioural support to active smokers in hospital and the systematic attachment to long term community follow-up services after discharge, with printed recommendations for continuing pharmacotherapies post-discharge. The community follow-up consisted of an automated telephone service providing 8 telephone calls over 6 months with access to counselling from smoking cessation nurse specialists in the event of relapse or low confidence. Outcomes were compared between 641 control smokers admitted to the 14 hospitals prior to the OMSC implementation and 726 intervention smokers admitted after the OMSC implementation. The control group received ‘usual care’ which typically consisted of a self-help brochure and very brief advice.
Available Downloads
Read the full Lancet EAGLE Study 2016
Hiding in plain sight Treating tobacco dependency in the NHS
A report by the Tobacco Advisory Group of the Royal College of Physicians
Foreword
Smoking kills, but is entirely preventable. All clinicians encounter smokers in their daily work, and most will have first-hand experience of caring for people whose lives have been destroyed by addiction to smoking tobacco. For nearly six decades, the Royal College of Physicians has led medical opinion on tobacco policy and clinical practice, and with the many other organisations and individuals involved in advocacy for smoking prevention has made a significant contribution to achieving a substantial fall in smoking prevalence in the UK. However, there is one area where policy and practice have singularly failed to achieve their potential, and that is in helping our patients who smoke to quit. Despite the availability of evidence-based clinical guidelines on smoking interventions in the UK for 20 years, smokers who use NHS facilities, and in particular our hospitals, are admitted and discharged without being asked if they are a smoker, or if asked, without being offered help, or if offered help, without that help being delivered at the time of the admission. Our consistent failure to act on the largest avoidable cause of premature death and disability in the UK needs to be remedied.
This report addresses the harms and costs arising from smoking in the patients we see every day, and argues for a new approach to treating their addiction. We argue that existing models of delivering stop smoking services separately from mainstream NHS services, while successful in the past, may now not be the best approach. We argue that responsibility for treating smokers lies with the clinician who sees them, and that our NHS should be delivering default, opt-out, systematic interventions for all smokers at the point of service contact. We demonstrate that clinicians working in almost all areas of medicine will see their patient’s problems improved by quitting smoking, and that systematic intervention is a cost-effective means of both improving health and reducing demand on NHS services. Smoking cessation is not just about prevention. For many diseases, smoking cessation represents effective treatment.
As doctors we must therefore recognise that treating tobacco dependence, effectively and routinely, is our business. Smoking cessation should be incorporated, as a priority, as a systematic and opt-out component of all NHS services, and delivered in smoke-free settings. It is unethical to do otherwise.
Professor Jane Dacre, President, Royal College of Physicians
