Increasing smoking cessation care provision in hospitals: a meta-analysis of intervention effect.
BACKGROUND
Levels of hospital smoking cessation care are less than optimal. This study aimed to synthesize the evidence regarding the effectiveness of interventions in increasing smoking cessation care provision in hospitals.


METHODS
A review identified relevant studies published between 1994 and 2006. A description of studies, including methodological quality, was undertaken. Intervention effectiveness in increasing smoking cessation care practices was examined for controlled studies using meta-analysis. Care practices examined were assessment of smoking status; advice to quit; counseling or assistance to quit; advising, offering, or providing nicotine replacement therapy (NRT); and follow-up or referral.


RESULTS
Of the 25 identified studies, 18 were U.S. based and in inpatient settings. Of the 10 controlled trials, 4 addressed cardiac patients, 5 measured one smoking cessation care practice, and 9 implemented multistrategic interventions (e.g., combining educational meetings with reminders and written resources). The methodology described in these studies was generally of poor quality. Meta-analysis of controlled trials demonstrated a significant intervention effect for provision of assistance and counseling to quit (pooled risk difference = 16.6, CI = 4.9-28.3) but not for assessment of smoking status, advice to quit, or the provision or discussion of NRT. Statistical heterogeneity was indicated for all smoking cessation care practices. An insufficient number of studies precluded the use of meta-analysis for follow-up or referral for further assistance.


CONCLUSIONS
Interventions can be effective in increasing the routine provision of hospital smoking cessation care. Future research should use more rigorous study design, examine a broader range of smoking cessation care practices, and focus on hospital-wide intervention implementation.
Hunter New England Population Health, Hunter New England Area Health Service, New South Wales, Australia. megan.freund@hnehealth.nsw.gov.au
Megan
M
Freund
Elizabeth
E
Campbell
Christine
C
Paul
Rebecca
R
Sakrouge
Patrick
P
McElduff
Raoul A
RA
Walsh
John
J
Wiggers
Jenny
J
Knight
Afaf
A
Girgis
D003376:Counseling / Q000706:statistics & numerical data; D006266:Health Education / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000628:therapy*