title: Systematic identification and treatment of smokers by hospital based cessation practitioners in a secondary care setting: cluster randomised controlled trial.
abstract: OBJECTIVE
  To investigate the effectiveness of the systematic default provision of smoking cessation support to all adult smokers admitted to hospital, relative to usual care.
  
  
  METHODS
  Open, cluster randomised controlled trial.
  
  
  METHODS
  Acute medical wards in one large teaching hospital in the United Kingdom.
  
  
  METHODS
  264 patients randomised to intervention and 229 to usual care; primary outcome data were available at four weeks for 260 and 224 patients, respectively. All adult smokers and recent ex-smokers able to give informed consent were eligible for entry into the study.
  
  
  METHODS
  The intervention comprised systematic smoking ascertainment and default provision of behavioural support and cessation pharmacotherapy for the duration of the hospital stay for all smokers and recent ex-smokers, with follow-up and referral to community services after discharge. Usual care comprised cessation support delivered at the initiative and discretion of clinical staff. All staff and patients were aware of group assignment.
  
  
  METHODS
  Smoking cessation at four weeks, validated by measuring exhaled carbon monoxide. Secondary outcomes were uptake of inpatient behavioural support, use of cessation pharmacotherapy, referral to and uptake of community support after discharge, and validated smoking cessation at six months. Participants lost to follow-up were assumed to have reverted to smoking.
  
  
  RESULTS
  All patients in the intervention group received at least brief advice to quit smoking, compared to 106 (46%) patients in the usual care group. Cessation at four weeks was achieved by 38% (n=98) of intervention patients and 17% (n=37) of usual care patients (adjusted odds ratio 2.10 (95% confidence interval 0.96 to 4.61), P=0.06, number of patients needed to treat 8). Uptake of inpatient behavioural support, use of pharmacotherapy, and referral to and uptake of community support after discharge were all substantially and statistically significantly higher in the intervention group than in the usual care group. Cessation at six months was achieved by 19% (n=47) of intervention and 9% (n=19) of usual care patients, although this difference was not significant (adjusted odds ratio 1.53 (95% confidence interval 0.60 to 3.91); P=0.37).
  
  
  CONCLUSIONS
  Substantial improvements in smoking cessation among smokers admitted to hospital can be achieved by systematic ascertainment and delivery of cessation support in secondary care.
  
  
  BACKGROUND
  International Standard Randomised Controlled Trial Number ISRCTN25441641.
authors.affiliation: Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB, UK. rachael.murray@nottingham.ac.uk
authors.forename: R L
authors.initials: RL
authors.lastname: Murray
authors.forename: J
authors.initials: J
authors.lastname: Leonardi-Bee
authors.forename: J
authors.initials: J
authors.lastname: Marsh
authors.forename: L
authors.initials: L
authors.lastname: Jayes
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: S
authors.initials: S
authors.lastname: Parrott
authors.forename: J
authors.initials: J
authors.lastname: Britton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D063127:Secondary Health Care / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D006113:United Kingdom; D055815:Young Adult