ANZSOG’s research program addresses key issues in public administration and policy. In the latest issue of our Evidence Base journal, Zoe Kopsaftis and colleagues review the evidence for how we can use the opportunity of hospital stays to encourage people to quit smoking. The evidence indicates it can be done – but probably not in the emergency department.
Cigarette smoking is a leading risk factor for poor health in Australia and New Zealand, costing billions of dollars each year through preventable disease, disability and death. Government policy initiatives such as tax increases, smoke-free public places and plain packaging have collectively helped to reduce tobacco prevalence.
However, it is important to keep making inroads on this complex public health problem, focusing not just on the population but also the individual.
A person’s hospital stay can provide a valuable teachable moment to introduce anti-smoking options – it is a time for them to reflect on their illness and lifestyle factors that potentially contribute. It also provides a period of abstinence, as hospital grounds are typically smoke-free zones. Furthermore, the hospital setting can provide a safe environment for anti-smoking medication under the supervision of health professionals.
With these factors in mind, it is important to establish what works in this setting so that policymakers can discuss appropriate action to maximise the potential of this opportunity. Unfortunately, interventions in hospitals are currently underused, and approaches to smoking cessation are outdated, ad hoc and unstandardised.
In order to identify strategies that are evidence based and proven to be effective in the hospital setting, we undertook a systematic review of the global scientific literature. The review highlighted the need for policymakers to consider not only the intervention to be used but also the type of patient.
Currently, the evidence suggests that patients admitted to a specialist cardiac ward respond effectively to a face-to-face discussion with a health professional, if there is provision of either in-person or telephone follow-up for a month after discharge. People admitted to general wards benefit from a similar counselling approach, but should have additional drug therapy added to their management to increase the chances of success. However, there were no strategies that appeared effective when administered in the emergency department. This is probably because emergency department visits are brief.
Evidence for use of technology to address the problem is currently lacking, though it is an area that is growing. But in the absence of this evidence, there are tangible approaches that can be implemented now.
Our review provides a guide for policymakers currently discussing or planning to discuss where to steer in-hospital approaches for smoking cessation. Strategies that have been demonstrated to be effective, e.g. counselling with post discharge follow-up, are reasonable and achievable in practice.
There is no need to re-invent the wheel: smoking cessation counselling interventions can successfully be embedded within already existing models of care, specifically by training ward nurses to counsel and provide follow-up.
Importantly, health professionals need to have access to adequate resources, time and training for implementation of effective smoking cessation strategies to reduce the burden of tobacco-related illnesses.