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Nicotine & Tobacco Research Advance Access published online on May 12, 2009
Nicotine & Tobacco Research, doi:10.1093/ntr/ntp061
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Can smokers switch from a hospital-based to a community-based stop smoking service? An open-label, randomized trial comparing three referral schemes

Keir E. Lewis, Linda Durgan, Victoria M. Edwards, Hazel Dixon, Carolyn Whitehead and Robert N. Sykes

Keir E. Lewis, M.D., Department of Respiratory Medicine, Prince Philip Hospital, Hywel Dda NHS Trust and Swansea University, Llanelli, Wales, UK
Linda Durgan, B.Sc., All Wales Smoking Cessation Service, St David's Hospital, Carmarthen, UK
Victoria M. Edwards, B.Sc., Audit Department, Prince Philip Hospital, Llanelli, Hywel Dda NHS Trust, Wales, UK
Hazel Dixon, R.N., C/O Respiratory Unit, Prince Philip Hospital, Llanelli, Hywel Dda NHS Trust, Wales, UK
Carolyn Whitehead, B.Sc., All Wales Smoking Cessation Service, St David's Hospital, Carmarthen, UK
Robert N. Sykes, Ph.D., Department of Psychology (Retired), Swansea University, Swansea, UK

Corresponding Author: Keir E. Lewis, M.D., Department of Respiratory Medicine, Prince Philip Hospital, Hywel Dda NHS Trust, Llanelli SA14 8QF, Wales, UK. Telephone: +44-1554-783133; Fax: +44-1554-783597; E-mail: k.e.lewis{at}swansea.ac.uk


  Abstract

Introduction: Many hospitals advise their smoking patients to contact a community-based stop smoking service. We investigated how well smokers attend a community-based service after receiving help from a hospital smoking cessation specialist (HSCS).

Methods: In this 55-week, single-blinded trial, 450 consecutive smokers, attending two U.K. hospitals, were randomized. Group A received a brief intervention consisting of a 20-min consultation from an HSCS and leaflets with contact information for their community-based service. Group B received a 60-min consultation, four weekly appointments with the HSCS, and leaflets with contact information for their community-based service. Group C received a 60-min consultation and four weekly appointments with the HSCS and then agreed to attend a scheduled appointment at the nearest community-based service within 1 week. Pharmacotherapy was recommended to all participants, and they were advised to attend the community-based service for ongoing support immediately and at Weeks 5, 12, 26, and 52. At 55 weeks, the HSCS contacted participants again, without warning, for validation.

Results: Community-based service attendance at 5 weeks was 7% in Group A, 4% in Group B, and 23% in Group C (p < .001). Over 12–26 weeks, rates of community-based service attendance were 6%–12% in all groups. These rates remained consistently higher in Group C (p < .05) but fell throughout the period to only 3%, 5%, and 7%, respectively, at 52 weeks (p = .26). HSCS attendance at 55 weeks and point prevalence, validated quit rates were 17% for Group A, 20% for Group B, and 22% for Group C (p = .75).

Discussion: A specific appointment improves immediate and medium-term attendance at the community-based service, but hospitalized smokers do not switch well to a community-based service following any referral strategy. However, a significant proportion made a repeat visit to the hospital-based program much later on.

Received: October 21, 2008; Accepted: February 22, 2009
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