Integrating smoking cessation into routine care in hospitals--a randomized controlled trial.

Abstract

To evaluate the effectiveness of a pharmacist-led multi-component smoking cessation programme (GIVE UP FOR GOOD) compared with usual care in hospitalized smokers. Randomized, assessor-blinded, parallel-group trial. Three tertiary public hospitals in Australia. A total of 600 adult in-patient smokers [mean±standard deviation (SD), age 51±14 years; 64% male] available for 12 months follow-up. Multi-component hospital pharmacist-led behavioural counselling and/or pharmacotherapy provided during hospital stay, on discharge and 1month post-discharge, with further support involving community health professionals (n=300). Usual care comprised routine care provided by hospitals (n=300). Two primary end-points were tested using intention-to-treat analysis: carbon monoxide (CO)-validated 1-month sustained abstinence at 6-month follow-up and verified 6-month sustained abstinence at 12-month follow-up. Smoking status and pharmacotherapy usage were assessed at baseline, discharge, 1, 6 and 12 months. Sustained abstinence rates for intervention and control groups were not significantly different at both 6months [11.6% (34 of 294) versus 12.6% (37 of 294); odds ratio (OR)=0.91, 95% confidence interval (CI)=0.55-1.50] and 12 months [11.6% (34 of 292) versus 11.2% (33 of 294); OR=1.04, 95% CI=0.63-1.73]. Secondary end-points, self-reported continuous abstinence at 6 and 12 months, also agreed with the primary end-points. Use of pharmacotherapy was higher in the intervention group, both during hospital stay [52.3% (157 of 300) versus 42.7% (128 of 300); P=0.016] and after discharge [59.6% (174 of 292) versus 43.5% (128 of 294); P<0.001]. A pharmacist-led multi-component smoking cessation intervention provided during hospital stay did not improve sustained abstinence rates at either 6 or 12 months compared with routine hospital care.