Cigarette smoking costs Australia and New Zealand billions of dollars per year and is the single most preventable risk to health. Though governments have initiated numerous public health policies which have reduced the incidence of smoking, current usage remains around 15 percent. Making further inroads is likely to require augmenting these interventions with action at the individual level. The hospital setting provides a unique opportunity to assess the efficacy of individual attention. The aim of this study is to make an initial assessment of this efficacy by collating the existing evidence of outcomes achieved by health professionals working with individuals in hospital settings. The systematic literature search resulted in 69 studies (72 citations) for evaluation. Results indicated that a multicomponent intervention comprised of high intensity counselling with a minimum of one month of post-discharge follow-up in addition to either nicotine replacement therapy or varenicline tartrate is the most effective combination of individual treatments for improving smoking abstinence, particularly for general inpatients. Further, there was an indication that patients admitted to specialist wards (e.g. cardiovascular) would benefit most from high intensity interventions, regardless of the use of adjunct pharmacotherapy. The evidence for a positive effect on sustained quit smoking rates for peri-operative patients is not definite, but as smoking adversely affects surgical success, implementing multicomponent interventions should still be considered. This review found no clear evidence to support implementation of smoking cessation interventions in the emergency department setting. Overall, interventions throughout the review were heterogeneous, making the estimate of a true effect difficult. Furthermore, there were only low numbers of local studies, with the findings of this review relying mostly upon extrapolation from overseas studies. Given the severity of the burden placed on the health system by smoking, there is a need for continuing endeavours by researchers with the support of the government to identify innovative and effective interventions for smokers that can be delivered by health professionals caring for smokers in the hospital setting.
Australia and New Zealand School of Government and the authors 2018