Enhanced smoking cessation support for newly abstinent smokers discharged from hospital (The Hospital to Home trial): A randomised controlled trial

Thorley, Rebecca; Britton, John; Nyakutsikwa, Blessing; Opazo Breton, Magdalena; Lewis, Sarah A.; Murray, Rachael L.

Abstract

Background and aims
The United Kingdom's National Institute for Health and Care Excellence guidance (NICE PH48) recommends that pharmacotherapy combined with behavioural support be provided for all smokers admitted to hospital; however, relapse to smoking after discharge remains common. This study aimed to assess the effect of adding home support for newly‐abstinent smokers to conventional NICE‐recommended support in smokers discharged from hospital.

Design
individually‐randomised parallel group trial.

Setting
One UK acute hospital.

Participants
404 smokers aged >18 admitted to acute medical wards between June 2016 and July 2017 were randomised in equal numbers to each treatment group.

Interventions and comparators
The intervention provided 12 weeks of at‐home cessation support which included help in maintaining a smoke‐free home, help in accessing and using medication, further behavioural support and personalised feedback on home air quality. The comparator was NICE PH48 care as usual.

Measures
The primary outcome was self‐reported continuous abstinence from smoking validated by an exhaled carbon monoxide level ≤6ppm four‐weeks after discharge from hospital.

Findings
In an intention‐to‐treat analysis at the four‐week primary endpoint, 38 participants (18.8%) in the usual care group and 43 (21.3%) in the intervention group reported continuous abstinence from smoking (odds ratio 1.17, 95% confidence interval 0.72 to 1.90, Bayes factor 0.33). There were no significant differences in any secondary outcomes, including self‐reported cessation at 3 months, having a smoke‐free home, or number of cigarettes smoked per day in those who did not quit.

Conclusions
Provision of a home visit and continued support to prevent relapse to smoking after hospital discharge did not appear to increase subsequent abstinence rate above usual care in accordance with UK guidance from the National Institute of Health and Care Excellence.

Citation

Thorley, R., Britton, J., Nyakutsikwa, B., Opazo Breton, M., Lewis, S. A., & Murray, R. L. (2019). Enhanced smoking cessation support for newly abstinent smokers discharged from hospital (The Hospital to Home trial): A randomised controlled trial. Addiction, 114(11), 2037-2047. https://doi.org/10.1111/add.14720

• Journal Article Type: Article
• Acceptance Date: Jun 14, 2019
• Online Publication Date: Jun 25, 2019
• Publication Date: Nov 1, 2019
• Deposit Date: Jul 3, 2019
• Publicly Available Date: Jun 26, 2020
• Journal: Addiction
• Print ISSN: 0965-2140
• Electronic ISSN: 1360-0443
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 114
• Issue: 11
• Pages: 2037-2047
• DOI: https://doi.org/10.1111/add.14720
• Public URL: https://nottingham-repository.worktribe.com/output/2263741
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14720
• Additional Information: This is the peer reviewed version of the following article: Thorley, R., Britton, J., Nyakutsikwa, B., Opazo Breton, M., Lewis, S. A., and Murray, R. L. ( 2019) Enhanced smoking cessation support for newly abstinent smokers discharged from hospital (The Hospital to Home trial): A randomised controlled trial, Addiction. https://doi.org/10.1111/add.14720. , which has been published in final form at https://doi.org/10.1111/add.14720.. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
• Contract Date: Jul 3, 2019