Occasional review
Interventions for smoking cessation in hospitalised patients: a
systematic review
M Munafòa, N Rigottib, T Lancastera, L Steada, M Murphya
a ICRF General
Practice Research Group, University of Oxford, Oxford OX3 7LF, UK, b General Medicine Division, Massachusetts General
Hospital, Boston, Massachusetts, USA
Correspondence to: Dr M Munafò marcus.munafo{at}dphpc.ox.ac.uk
Received 9 January 2001; Returned to authors 2 March 2001; Revised version received 3 May 2001; Accepted for publication 9 May 2001
BACKGROUND
An
admission to hospital provides an opportunity to help people stop
smoking. Individuals may be more open to help at a time of perceived
vulnerability, and may find it easier to quit in an environment where
smoking is restricted or prohibited. Providing smoking cessation
services during hospitalisation may help more people to attempt and
sustain an attempt to quit. The purpose of this paper is to
systematically review the effectiveness of interventions for smoking
cessation in hospitalised patients.
METHODSWe
searched the Cochrane Tobacco Addiction Group register, CINAHL, and the
Smoking and Health database for studies of interventions for smoking
cessation in hospitalised patients. Randomised and quasi-randomised
trials of behavioural, pharmacological, or multi-component interventions to help patients stop smoking conducted with hospitalised patients who were current smokers or recent quitters were included. Studies of patients admitted for psychiatric disorders or substance abuse, those that did not report abstinence rates, and those with follow up of less than 6 months were excluded. Two of the authors extracted data independently for each paper, with assistance from others.
RESULTSIntensive
intervention (inpatient contact plus follow up for at least 1 month)
was associated with a significantly higher cessation rate compared with
controls (Peto odds ratio (OR) 1.82, 95% CI 1.49 to 2.22). Any contact
during hospitalisation followed by minimal follow up failed to detect a
statistically significant effect on cessation rate, but did not rule
out a 30% increase in smoking cessation (Peto OR 1.09, 95% CI 0.91 to
1.31). There was insufficient evidence to judge the effect of
interventions delivered only during the hospital stay. Although the
interventions increased quit rates irrespective of whether nicotine
replacement therapy (NRT) was used, the results for NRT were compatible
with other data indicating that it increases quit rates. There was no
strong evidence that clinical diagnosis affected the likelihood of quitting.
CONCLUSIONSHigh
intensity behavioural interventions that include at least 1 month of
follow up contact are effective in promoting smoking cessation in
hospitalised patients.
© 2001 by Thorax
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