3 April 2024

Researchers at King's College London have evaluated a smoking cessation service for patients admitted to two major hospitals in south east London, providing important new evidence to support rolling out similar tobacco dependency treatment services in other NHS hospitals.   

The study, published in BMC Medicine, assessed the uptake and impact of an adapted Ottawa Model for Smoking Cessation (OMSC) at King's College Hospital and St Thomas' Hospital in south east London. Both hospitals serve a diverse population, which includes many of the groups that suffer health inequalities and disproportionate harm from smoking. 

Under the OMSC service, patients admitted to hospital who smoked were offered bedside counselling from tobacco dependence specialists and nicotine replacement therapy. Patients were also offered six months of follow-up phone support after discharge from hospital.

“A hospital admission provides a critical window to help patients who smoke to quit, but these opportunities are often missed,” says lead-author Dr John Robins, research associate at King’s College London, and a member of ARC South London’s public health and multimorbidity theme. “With smoking contributing to more than 500,000 hospital admissions each year at an estimated cost of £850 million, implementing effective smoking cessation services is crucial for both patient health and the NHS." 

The research team conducted a year-long evaluation of how well the OMSC service worked in a real-word setting at King's College Hospital and St Thomas' Hospital, examining quit rates, and hospital readmission or death within 12 months. 

From July 2020 to July 2021, the OMSC intervention was targeted at 2,067 patients who smoked. The researchers’ analysis of electronic health records data for those patients found promising results.

Most patients (79.4%) accepted support at their initial consultation. At six-months post-discharge, 35.1% of successfully contacted patients reported having quit smoking, which is comparable to other OMSC implementation sites internationally.

However, outcomes varied substantially based on patient demographics and diagnoses. Patients of mixed, Asian or other non-white ethnicity had around 60% lower odds of quitting successfully compared to white patients, despite being more likely to initially accept support.

The researchers say this reflects international findings that diverse ethnic groups respond differently to smoking cessation interventions, and culturally tailored interventions may improve outcomes. 

The study also showed that younger people (aged 16-24) and patients with greater nicotine dependence were less likely to quit smoking successfully. 

Conversely, patients with diabetes or a stated intention to quit smoking had a greater chance of quitting successfully. Overall, 17.8% of patients who intended to quit reported being a non-smoker at 6-months after discharge, compared to 5.1% of those who only intended to temporarily abstain while in hospital, or to quit without using smoking cessation aids.

There was a high rate of patient acceptance of support for smoking cessation treatment, including for people with mental health conditions, which dispels the myth that people with mental health conditions are not motivated to quit smoking. 

“Outcomes varied considerably according to patient characteristics and between the two hospital sites, possibly due to the difference in how the service was implemented between the two Trusts and average length of stay on the wards at the two hospitals [one day vs six days], demonstrating the need for further research to optimise implementing inpatient tobacco treatment,” says co-author Dr Irem Patel, consultant integrated respiratory physician, King’s College Hospital NHS Foundation Trust, and Joint Director of Clinical Strategy, King’s Health Partners.

Dr Patel added the new research provides important evidence to inform the implementation of King’s Health Partners and South East London Integrated Care System’s joint ‘Vital 5’ programme, which is addressing the five leading causes of poor health and health inequalities in south east London: high blood pressure, obesity, smoking, alcohol and common mental health conditions.

As part of the programme, all patients who smoke who are admitted to any hospital in south east London will be offered support to quit.

The study's authors call for promoting hospital admissions as a springboard to address tobacco dependence in the long-term rather than simply something patients who smoke have to temporarily stop doing during a stay in hospital. They also recommend analysing how multiple health conditions impact outcomes, and conducting more granular research into the effects of mental health disorders and role of ethnicity, which may inform culturally tailored interventions.

"This was an excellent example of university-NHS partnership – involving two major teaching hospitals, King’s Health Partners, the NHS South East London Integrated Care System and King’s College London – to address the leading preventable cause of death in our local population and beyond," says Dr Debbie Robson, senior lecturer in tobacco harm reduction, King’s College London and the ARC’s public health and multimorbidity theme lead. "Helping patients who smoke to quit during admissions could dramatically improve their lives while benefitting our healthcare system."

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This study is funded by Southwark Clinical Commissioning Group (CCG) and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust.