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Smoking cessation in hospitals could cut smoking rates significantly

Clinicians should make better use of opportunities to help people quit smoking when people are in hospitals in England for the 2.6million episodes of care that take place every year for smokers.

It is estimated that around 460,000 adult admissions to NHS hospitals in England every year are due to smoking. Treating diseases caused by smoking costs the NHS more than £5 billion per year, about 5% of its annual budget, despite the fact that smoking is preventable and treatable.

Many hospital admissions, therefore, are an avoidable drain on scarce NHS resources, but the proportion of smokers who receive treatment for smoking are low.

In 2013, guidance was issued by the National Institute for Health and Care Excellence (NICE) that recommended the routine and systematic delivery of cessation support to all smokers using secondary care services, but the prevalence of smoking among those treated in NHS hospitals, and hence the number of people who might benefit, is unknown.

Researchers from the UK Centre for Tobacco and Alcohol Studies at the University of Nottingham, and Institute for Lung Health at Glenfield Hospital, set out to calculate the prevalence of smoking amongst inpatients in English hospitals, the number of smokers treated and the number of potential opportunities for smoking cessation, by treatment speciality in the year 2010-2011.

They used data from more than half a million patients registered with one of 72 general practices that contributed to the The Health Improvement Network (THIN) database and from linked Hospital Episode Statistics to see how many had experienced treatment at hospital.

The data showed that there were 80,007 (14.5%) people who experienced 172,537 finished consultant episodes in total, delivered over 151,342 inpatient spells.

Their findings indicate that in 2010-11 around 1.1 million smokers were admitted to hospitals in England, receiving 2.6 million episodes of care. They also found that whilst an average of one in six people admitted to hospital is a current smoker, this figure was three times higher among people with mental health problems, over half of whom were smokers.

The authors said that their findings demonstrate that providing intensive smoking cessation help to smokers treated as inpatients in hospitals had the potential to reach 1.1 million smokers each year; and hence to prevent hundreds of thousands of premature deaths.

In addition, routine provision of smoking cessation support to smokers seen as outpatients would further increase the number of smokers reached.

They concluded: "Implementation of current NICE guidance to deliver smoking cessation interventions as a routine component of secondary care provision could have a major impact on the prevalence of smoking, and hence on the morbidity and mortality that smoking causes."

A British Thoracic Society spokesman commented: "Smokers who are admitted to hospital include some of the poorest members of our society. This study shows that the NHS is missing regular opportunities to transform their lives through simple yet highly cost-effective measures to help them stop smoking.

"The health services regulators (CQC and Monitor) need to hold hospital chief executives to account and stop them ignoring the National Institute for Health and Care Excellence (NICE) recommendations to help people admitted to hospital to quit smoking."


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