Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB, UK.
BMJ. 2013 Jul 8;347:f4004. doi: 10.1136/bmj.f4004.
To investigate the effectiveness of the systematic default provision of smoking cessation support to all adult smokers admitted to hospital, relative to usual care.
Open, cluster randomised controlled trial.
Acute medical wards in one large teaching hospital in the United Kingdom.
264 patients randomised to intervention and 229 to usual care; primary outcome data were available at four weeks for 260 and 224 patients, respectively. All adult smokers and recent ex-smokers able to give informed consent were eligible for entry into the study.
The intervention comprised systematic smoking ascertainment and default provision of behavioural support and cessation pharmacotherapy for the duration of the hospital stay for all smokers and recent ex-smokers, with follow-up and referral to community services after discharge. Usual care comprised cessation support delivered at the initiative and discretion of clinical staff. All staff and patients were aware of group assignment.
Smoking cessation at four weeks, validated by measuring exhaled carbon monoxide. Secondary outcomes were uptake of inpatient behavioural support, use of cessation pharmacotherapy, referral to and uptake of community support after discharge, and validated smoking cessation at six months. Participants lost to follow-up were assumed to have reverted to smoking.
All patients in the intervention group received at least brief advice to quit smoking, compared to 106 (46%) patients in the usual care group. Cessation at four weeks was achieved by 38% (n=98) of intervention patients and 17% (n=37) of usual care patients (adjusted odds ratio 2.10 (95% confidence interval 0.96 to 4.61), P=0.06, number of patients needed to treat 8). Uptake of inpatient behavioural support, use of pharmacotherapy, and referral to and uptake of community support after discharge were all substantially and statistically significantly higher in the intervention group than in the usual care group. Cessation at six months was achieved by 19% (n=47) of intervention and 9% (n=19) of usual care patients, although this difference was not significant (adjusted odds ratio 1.53 (95% confidence interval 0.60 to 3.91); P=0.37).
Substantial improvements in smoking cessation among smokers admitted to hospital can be achieved by systematic ascertainment and delivery of cessation support in secondary care.
International Standard Randomised Controlled Trial Number ISRCTN25441641.
与常规护理相比，调查对所有住院成年吸烟者系统默认提供戒烟支持的效果。
开放、整群随机对照试验。
英国一家大型教学医院的急性内科病房。
264 名随机分配至干预组和 229 名随机分配至常规护理组的患者；分别有 260 名和 224 名患者在四周时可获得主要结局数据。所有成年吸烟者和最近戒烟者，只要能知情同意，均有资格进入该研究。
干预措施包括对所有吸烟者和最近戒烟者进行系统的吸烟情况调查，并在住院期间默认提供行为支持和戒烟药物治疗，在出院后提供随访和转介至社区服务。常规护理包括临床工作人员主动和酌情提供的戒烟支持。所有工作人员和患者均了解分组情况。
通过测量呼出的一氧化碳来验证四周时的戒烟情况。次要结局包括住院期间接受行为支持、使用戒烟药物治疗、出院后转介和接受社区支持，以及六个月时的经证实的戒烟情况。失访的参与者被假定为恢复吸烟。
与常规护理组的 106 名患者（46%）相比，干预组的所有患者均至少接受了简短的戒烟建议。干预组在四周时戒烟的比例为 38%（n=98），常规护理组为 17%（n=37）（调整后的优势比 2.10（95%置信区间 0.96 至 4.61），P=0.06，需要治疗的患者数为 8）。在干预组中，住院期间接受行为支持、使用药物治疗、出院后转介和接受社区支持的比例均明显高于常规护理组，且差异具有统计学意义。干预组在六个月时戒烟的比例为 19%（n=47），常规护理组为 9%（n=19），尽管这一差异无统计学意义（调整后的优势比 1.53（95%置信区间 0.60 至 3.91）；P=0.37）。
通过在二级护理中系统地确定并提供戒烟支持，可以显著提高住院吸烟者的戒烟率。
国际标准随机对照试验编号 ISRCTN25441641。
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