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. 2017 May;26(3):293-299.
doi: 10.1136/tobaccocontrol-2015-052728. Epub 2016 May 25.

Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes

Kerri A Mullen  1 , Douglas G Manuel  2 , Steven J Hawken  2 , Andrew L Pipe  1 , Douglas Coyle  3 , Laura A Hobler  1 , Jaime Younger  2 , George A Wells  1 , Robert D Reid  1
Affiliations

Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes

Kerri A Mullen et al. Tob Control. 2017 May.

Abstract

Background: Tobacco-related illnesses are leading causes of death and healthcare use. Our objective was to determine whether implementation of a hospital-initiated smoking cessation intervention would reduce mortality and downstream healthcare usage.

Methods: A 2-group effectiveness study was completed comparing patients who received the 'Ottawa Model' for Smoking Cessation intervention (n=726) to usual care controls (n=641). Participants were current smokers, >17 years old, and recruited during admission to 1 of 14 participating hospitals in Ontario, Canada. Baseline data were linked to healthcare administrative data. Competing-risks regression analysis was used to compare outcomes between groups.

Results: The intervention group experienced significantly lower rates of all-cause readmissions, smoking-related readmissions, and all-cause emergency department (ED) visits at all time points. The largest absolute risk reductions (ARR) were observed for all-cause readmissions at 30 days (13.3% vs 7.1%; ARR, 6.1% (2.9% to 9.3%); p<0.001), 1 year (38.4% vs 26.7%; ARR, 11.7% (6.7% to 16.6%); p<0.001), and 2 years (45.2% vs 33.6%; ARR, 11.6% (6.5% to 16.8%); p<0.001). The greatest reduction in risk of all-cause ED visits was at 30 days (20.9% vs 16.4%; ARR, 4.5% (0.4% to 8.7%); p=0.03). Reduction in mortality was not evident at 30 days, but significant reductions were observed by year 1 (11.4% vs 5.4%; ARR 6.0% (3.1% to 9.0%); p<0.001) and year 2 (15.1% vs 7.9%; ARR, 7.3% (3.9% to 10.7%); p<0.001).

Conclusions: Considering the relatively low cost, greater adoption of hospital-initiated tobacco cessation interventions should be considered to improve patient outcomes and decrease subsequent healthcare usage.

Keywords: Cessation; Health Services; Priority/special populations.

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Conflict of interest statement

Competing interests: KAM, ALP and RDR are inventors of the Ottawa Model for Smoking Cessation, a registered trademark of the University of Ottawa Heart Institute. ALP has received payment for consultancy from Pfizer Inc., Johnson & Johnson and Glaxo Smith Klein, and for lectures from Johnson & Johnson and Pfizer Inc. He has received research funding from Pfizer Inc. RDR has received payment for lectures from Johnson & Johnson and Pfizer Inc. and is currently holding a research grant through the Pfizer Global Research Awards for Nicotine Dependence competition. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
30-day, 1-year and 2-year outcomes of competing-risk regression for smokers receiving either OMSC (intervention, n=726) or usual care (control, n=641). AR, attributable risk; ED, emergency department; GP, general practitioner; NNT/H, number needed to treat/harm (negative values represent number needed to harm); Phys, physician; rel, related. A, adjusted for baseline covariates: age, sex, income, number of cigarettes smoked per day, community size, resource usage prior to index event, and history of: acute myocardial infarction, asthma, chronic obstructive pulmonary disease, heart failure, diabetes, hypertension, mental illness, stroke/transient ischemic attack.
Figure 2
Figure 2
Cumulative incidence of mortality (Part A) and all-cause rehospitalisation (Part B) from index hospitalisation to 2-year follow-up in the control (n=641) and intervention (n=726) groups.
See this image and copyright information in PMC

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