Helping smokers quit in secondary-care services

Abstract

The landscape for cigarette smokers in the UK has changed almost beyond recognition in the past decade, but about a fifth of the adult population still smokes, and many of those who need hospital admission smoke. The prevalence of tobacco smoking is particularly high in those with mental health problems—a third smoke, and more than two thirds of those in psychiatric units smoke. To promote smoking cessation in secondary care, particularly in acute, maternity, and mental health services, the National Institute for Health and Care Excellence (NICE) published comprehensive guidance on Nov 27.A principle behind the new NICE guidance is that no concessions are made to smokers who use secondary care services, no matter what their level of mobility or freedom might be. So, for example, the guidance recommends that those compulsorily detained in psychiatric units should not be allowed to smoke tobacco, and that no designated smoking areas or staff-facilitated smoking breaks are to be provided in any type of secondary care. Instead, smokers should be offered licensed nicotine-replacement therapies, or varenicline, or bupropion as appropriate, and support from a smoking cessation adviser during their hospital admission. Intensive stop smoking support, including exhaled carbon monoxide measurements, is recommended for those in acute, mental health, or maternity services. Family members will also be provided with information about the dangers of smoking and secondhand smoke, and referral to a stop smoking adviser if they wish. The NICE guidance recommends that secondary-care staff should not be allowed to smoke at work at all, and should instead be offered pharmacotherapy or behavioural support.The group who developed the NICE guidance, led by John Britton, has concluded that all the recommended approaches are cost effective. Whether the guidance proves acceptable, workable, and effective in practice remains to be seen. Few foresaw the dramatic impact that banning smoking in enclosed public or workplaces would have when the Health Act in July, 2007, came into force in England. Tackling smoking in secondary care could prove to be a further big step towards a tobacco-free country. The landscape for cigarette smokers in the UK has changed almost beyond recognition in the past decade, but about a fifth of the adult population still smokes, and many of those who need hospital admission smoke. The prevalence of tobacco smoking is particularly high in those with mental health problems—a third smoke, and more than two thirds of those in psychiatric units smoke. To promote smoking cessation in secondary care, particularly in acute, maternity, and mental health services, the National Institute for Health and Care Excellence (NICE) published comprehensive guidance on Nov 27. A principle behind the new NICE guidance is that no concessions are made to smokers who use secondary care services, no matter what their level of mobility or freedom might be. So, for example, the guidance recommends that those compulsorily detained in psychiatric units should not be allowed to smoke tobacco, and that no designated smoking areas or staff-facilitated smoking breaks are to be provided in any type of secondary care. Instead, smokers should be offered licensed nicotine-replacement therapies, or varenicline, or bupropion as appropriate, and support from a smoking cessation adviser during their hospital admission. Intensive stop smoking support, including exhaled carbon monoxide measurements, is recommended for those in acute, mental health, or maternity services. Family members will also be provided with information about the dangers of smoking and secondhand smoke, and referral to a stop smoking adviser if they wish. The NICE guidance recommends that secondary-care staff should not be allowed to smoke at work at all, and should instead be offered pharmacotherapy or behavioural support. The group who developed the NICE guidance, led by John Britton, has concluded that all the recommended approaches are cost effective. Whether the guidance proves acceptable, workable, and effective in practice remains to be seen. Few foresaw the dramatic impact that banning smoking in enclosed public or workplaces would have when the Health Act in July, 2007, came into force in England. Tackling smoking in secondary care could prove to be a further big step towards a tobacco-free country.