Increasing smoking cessation care across a network of hospitals: an implementation study.

Carolyn Slattery,Jenny Knight,Luke Wolfenden,Megan Freund,Alessandra Bisquera,John Wiggers,Karen Gillham

doi:10.1186/s13012-016-0390-x

Abstract

BackgroundDespite clinical practice guidelines recommending the provision of smoking cessation care to all smokers in hospital, the provision of such care can be sub-optimal. A study was conducted to assess the impact of an intervention on the provision of smoking cessation care to nicotine-dependent smokers across a network of hospitals.MethodsA 4-year interrupted time series study was undertaken in a single health district in New South Wales, Australia. A multi-component intervention was implemented over a 2-year period in all 37 public general hospitals. Outcome data were collected from eight randomly selected hospitals via medical record audit. Logistic regression analyses assessed differences between baseline, intervention and follow-up periods in the provision of seven measures of care: brief advice, offer and provision of inpatient and discharge nicotine replacement therapy, and offer and acceptance of referral to a Quitline.ResultsApproximately 164,250 patients were discharged from the hospitals during the study, 16 % of whom were smokers. Of the selected smokers, 56.12 % (n = 2072) were nicotine-dependent. The prevalence of smoking cessation care increased significantly for all seven measures between baseline and intervention periods, and for six of the seven measures between the baseline and follow-up periods. The odds of receiving care at follow-up were between 1.7 (CI 1.18–2.58, p = 0.0004) and 6.2 (CI 2.84–13.85, p < 0.0001) times greater than at baseline. At follow-up, 53, 16 and 7 of smokers were offered inpatient NRT, discharge NRT and a Quitline referral, respectively.ConclusionsSignificant gains in the provision of smoking cessation care were indicated. However, at best, slightly more than half of the patients received smoking cessation care. Additional care enhancement strategies are required if all smokers are to obtain the intended benefits of smoking cessation care guidelines.

Highlights

Despite clinical practice guidelines recommending the provision of smoking cessation care to all smokers in hospital, the provision of such care can be sub-optimal
Despite the suggestion of almost universal and sustained access to such care, interpretation of such findings is constrained by the data being reported only for those patients admitted for three specific conditions, addressing only one element of evidence-based smoking cessation care [15, 16] and the risk of bias associated with hospital self-report of care delivery [20]
This study suggests that a network-wide practice change intervention increased both the offer and acceptance of multiple forms of smoking cessation care

Summary

Introduction

Despite clinical practice guidelines recommending the provision of smoking cessation care to all smokers in hospital, the provision of such care can be sub-optimal. Despite the success of tobacco control initiatives in many countries, the prevalence of smoking remains unacceptably high [1, 2] To reduce this burden at both the individual and population levels, smoking cessation clinical practice guidelines recommend the provision of smoking cessation care to all smokers attending health services. Despite such guidelines, the provision of such care is less than optimal within the USA, Australia and other. Considerable variability in the provision of such care has been reported by both type of hospital and type of patient [16]

Methods

Results

Conclusion