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When people come into hospital we have an ideal opportunity to treat their tobacco addiction and achieve long lasting quits

The SYB QUIT Programme is an evidence based programme. It has been designed on:

  • Research findings from the Ottawa Model Of Smoking Cessation
  • The London Senate Model and the Greater Manchester CURE Programme
  • NICE Public Health Guidance 48 Smoking: Acute, Maternity and Mental Health Services

By implementing the QUIT Programme and treating tobacco addiction we will save lives, decrease health inequalities and reduce NHS demand.

The Royal College of Physicians report Hiding in Plain Sight (2018) concluded that the evidence base for treating tobacco addiction in hospitals is so strong that:

As doctors we must recognise that treating tobacco dependence effectively and routinely is our business. Smoking cessation should be incorporated, as a priority, as a systematic and opt-out component of all NHS services, and delivered in smoke free settings. It is unethical to do otherwise.

Health service commissioners & practitioners have a responsibility to ensure that cost effective smoking interventions are provided and properly implemented. Failure to identify and treat smokers is no less negligent than failure to identify & treat patients with cancer. System failure is no less negligent in this respect than individual failure.

Prof Jane Dacre, President, RCP

The Ottawa Model for Smoking Cessation

Data from Canada has demonstrated that comprehensive secondary care treatment programmes for tobacco addiction deliver immediate and highly significant reductions in admission rates and mortality.

The Ottawa Model of Smoking Cessation (OMSC) tested the effectiveness of a hospital-initiated smoking cessation programme across 14 hospitals in Canada. The core components of this model were: the systematic identification and documentation of all smokers admitted to hospital, the systematic administration of pharmacotherapy & behavioural support to active smokers in hospital and the systematic attachment to long term community follow-up services after discharge, with printed recommendations for continuing pharmacotherapies post-discharge.

The community follow-up consisted of an automated telephone service providing 8 telephone calls over 6 months with access to counselling from smoking cessation nurse specialists in the event of relapse or low confidence. Outcomes were compared between 641 control smokers admitted to the 14 hospitals prior to the OMSC implementation and 726 intervention smokers admitted after the OMSC implementation. The control group received ‘usual care’ which typically consisted of a self-help brochure and very brief advice.

The Ottawa Study found :

  • An 11.1 percentage point increase (from 18.3% to 29.4%) in long-term quit rates among general patient population.[1]
  • 35% of the patients who received the OMSC were smoke-free at 6-months, compared to only 20% of the usual care participants.[2]
  • Patients who received the OMSC were 50% less likely to be re-admitted to the hospital for any cause, and 30% less likely to visit an emergency department within 30 days;
  • Smokers who received the OMSC were 21% less likely to be re-hospitalized and 9% less likely to visit an emergency department over 2 years;
  • Most importantly, smokers who received the OMSC had a 40% reduction in risk of death over 2 years.    

 

If South Yorkshire and Bassetlaw has the same outcomes as seen in Ottawa then we could within a year:

  • Save 2,000 lives
  • Prevent 2,000 30 day readmissions
  • Prevent 4,000 readmissions overall
  • Help 5,000 patients to quit at 6 month
  • Save £7.1m from acute Trust readmissions within a year


The table below breaks this down by Clinical Commissioning Group.

Anticipated outcomes in South Yorkshire and Bassetlaw if the Ottawa outcomes are replicated in our patients who have an admission in an Acute Trust by Clinical Commissioning Group.

 

Reduction by CCG 

 

Barnsley

Bassetlaw

Doncaster

Rotherham

Sheffield

Total

Estimated number SYB spells who are smokers (1)*

7,081

2,666

8,412

6,385

13,310

37,853

Mortality at 1 year

425

160

505

383

799

2,271

Mortality at 2 years

510

192

606

460

958

2,725

Readmission at 30 days

439

165

522

396

825

2,347

Readmission at 1 year

828

312

984

747

1,557

4,429

Quit rates at 6 months

1,062

400

1,262

958

1,996

5,678

ED attendances

319

120

379

287

599

1,703

Saving on readmission costs at one year (2)

£1,327k

£500k

£1,578k

£1,998k

£2,496k

£7.1m

Saving on ED costs at 30 days

£51k

£19k

£61k

£46k

£956k

£273k

Total Savings from admissions within a year ED within 30 days (gross)

£1.4m

£519k

£1.6m

£1.2m

£2.6m

£7.4m

[1] Reid RD, Mullen KA, Slovinec D’Angelo ME, Aitken DA, Papadakis S, Haley PM, et al. Smoking cessation for hospitalized smokers: an evaluation of the “Ottawa Model”. Nicotine Tob Res. 2010;12(1):11-8.  

[2] Mullen KA, Manuel DG, Hawken SJ, et al. Tob Control Published Online First: 2016. doi:10.1136/tobaccocontrol- 2015-052728 

(1)* Assumes 20% of spells are smokers, excludes day cases and maternity, aged over 15 years

 

The CURE project

The first six months of data from Wythenshawe Hospital in Greater Manchester, which has recently implemented an Ottawa like model (branded the CURE project) demonstrates that the model can be embedded quickly within UK acute trust hospital setting and with impressive results (see figure below).

 

1 in 4 of all smokers admitted to Whythenshaw hospital had quit at 4 weeks
 
Outcomes: 6 Months of CURE at Wythenshawe Hospital

2393 SMOKERS

Admitted to Wythenshawe

96%

2308
Provided with
brief advice by
admitting team

52%

1224
Prescribed with
NRT by admitting
team

61%

1450
have had a
specialist
assessment with
CURE team

10%

Smokers
prescribed
varenicline as an
inpatient

824

CURE team have provided 824 medication
prescriptions/changes

QUIT RATE: 42%

at 4 weeks in those patients supported by
the CURE team

At the 12 week follow-up (therefore covering the first 3 months of CURE) 332
patients had stopped smoking since their hospital admission

Further information about the Cure Programme can be found on their website:
thecureproject.co.uk
 

People with a mental health condition who smoke want to quit just as much as smokers in the general population, but often lack confidence in their ability to do so. They may, therefore, be less likely to make a quit attempt compared to smokers in the general population. People who use mental health services, who smoke, often historically have not been offered a way out of tobacco dependence that is genuinely helpful to them.

For people with mental ill health, research has demonstrated that health systems should provide smoking cessation services tailored and responsive to the needs of people who use these services. The recent SCIMITAR trial (3) found that when people in primary care and community mental health services with severe mental illness are provided with a bespoke smoking cessation intervention (delivered by mental health staff), smoking quit rates were doubled compared to those with usual care - with a 15.2% quit rate at 12 months.

In addition to the well-established benefits of increased life expectancy and improved physical health, stopping smoking in people with mental illness is associated with: (4)

  • Reduced depression, anxiety and stress
  • Improved positive mood and quality of life
  • More disposable income
  • Doses of some medicines, such as clozapine and olanzapine, can be reduced up to 25% in the first week after stopping smoking.

(3) Gilbody S, Peckham E, Bailey D, Arundel C et al Smoking cessation for people with severe mental illness (SCIMITAR+): a pragmatic randomised controlled trial, Lancet. VOLUME 6, ISSUE 5, P379-390, MAY 01, 2019

(4) Smoking cessation and smokefree policies: Good practice for mental health services, National Centre for Smoking Cessation and Training (NCSCT), March 2018