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Intervention Review

Interventions for smoking cessation in hospitalised patients

  1. Nancy Rigotti1,*,
  2. Marcus R Munafo'2,
  3. Lindsay F Stead3

Editorial Group: Cochrane Tobacco Addiction Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 19 MAY 2007

DOI: 10.1002/14651858.CD001837.pub2

How to Cite

Rigotti N, Munafo' MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD001837. DOI: 10.1002/14651858.CD001837.pub2.

Author Information

  1. 1

    Massachusetts General Hospital, General Internal Medicine Unit, Boston, MA, USA

  2. 2

    University of Bristol, Department of Experimental Psychology, BRISTOL, UK

  3. 3

    University of Oxford, Department of Primary Health Care, Oxford, UK

*Nancy Rigotti, General Internal Medicine Unit, Massachusetts General Hospital, S50-9, Boston, MA, 02114, USA. nrigotti@partners.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

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This is not the most recent version of the article. View current version (16 MAY 2012)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Initiating smoking cessation services during hospitalisation may help more people to make and sustain a quit attempt.

Objectives

To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients.

Search methods

We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PSYCINFO in January 2007, and CINAHL in August 2006 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted.

Selection criteria

Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted for psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow up of less than six months.

Data collection and analysis

Two authors extracted data independently for each paper, with disagreements resolved by consensus.

Main results

Thirty-three trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (Odds Ratio (OR) 1.65, 95% confidence interval (CI) 1.44 to 1.90; 17 trials). No statistically significant benefit was found for less intensive counselling interventions. The one study that tested a single brief (<=15 minutes) in-hospital intervention did not find it to be effective (OR 1.16, 95% CI 0.80 to 1.67). Counselling of longer duration during the hospital stay was not associated with a higher quit rate (OR 1.08, 95% CI 0.89 to 1.29, eight trials). Even counselling that began in the hospital but had less than one month of supportive contact after discharge did not show significant benefit (OR 1.09, 95% CI 0.91 to 1.31, six trials). Adding nicotine replacement therapy (NRT) did not produce a statistically significant increase in cessation over what was achieved by intensive counselling alone (OR 1.47, 95% CI 0.92 to 2.35, five studies). The one study that tested the effect of adding bupropion to intensive counselling had a similar nonsignificant effect (OR 1.56, 95% CI 0.79 to 3.06). A similar pattern of results was observed in smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the odds of smoking cessation (OR 1.81, 95% CI 1.54 to 2.15, 11 trials), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period.

Authors' conclusions

High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. These interventions are effective regardless of the patient's admitting diagnosis. lnterventions of lower intensity or shorter duration have not been shown to be effective in this setting. There is insufficient direct evidence to conclude that adding NRT or bupropion to intensive counselling increases cessation rates over what is achieved by counselling alone, but the evidence of benefit for NRT has strengthened in this update and the point estimates are compatible with research in other settings showing that NRT and bupropion are effective.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Do smoking cessation interventions started during hospitalisation help people to stop smoking

Smoking contributes to many health problems including cancers, cardiovascular disease, and lung diseases. Smoking also increases the risk associated with hospitalisation for surgery. People who are in hospital because of a smoking-related illness are likely to be more receptive to help to give up smoking. Our review of trials found that programmes to stop smoking that begin during a hospital stay and include follow-up support for at least one month after discharge are effective. Such programmes are effective when administered to all hospitalised smokers, regardless of admitting diagnosis, and in the subset of smokers who are admitted to hospital with cardiovascular disease.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

住院病人的戒菸介入處置

住院提供了幫助患者成功戒菸的機會。在感覺到自己的脆弱性時,人們比較願意接受協助,在一個吸菸是受限制或被禁止的環境也可能比較容易戒菸。在住院期間提供戒菸服務可能可以協助更多人決定並維持戒菸的嘗試

目標

評估對住院病人提供戒菸治療的效果

搜尋策略

我們搜尋了Cochrane Tobacco Addiction Group,此資料庫包含了來自於CENTRAL、MEDLINE、EMBASE與PSYCINFO(2007年1月)與CINAHL(2006年8月)中對於住院病人提供戒菸介入處置的研究,使用(hospital與patient∗)或hospitali∗或inpatient∗或admission∗或admitted來搜尋

選擇標準

對目前有吸菸或最近戒菸(定義為在入院前已戒菸超過一個月)的住院病人,以行為、藥物或多元介入處置協助病人戒菸的隨機試驗及類隨機試驗。介入處置在住院期間開始,但可以在出院後仍持續。我們排除因精神疾病或物質濫用而住院的病人,以及沒有呈現戒菸率、追蹤期短於六個月的研究

資料收集與分析

兩位作者獨立地從各個文獻擷取資料,若有不同的意見則取得共識來解決

主要結論

33個試驗符合納入的標準。在住院期間進行密集的諮商並在出院後至少給予一個月的支持性接觸,會增加出院後的戒菸率(勝算比 (OR) 1.65, 95% 信賴區間 (CI) 1.44 to 1.90; 17個試驗)。較不密集的諮商介入則沒有統計上顯著的效果。有一個研究檢驗住院期間一次簡短(小於15分鐘)的會談並沒有效果(OR 1.16, 95% CI 0.80 to 1.67)。住院期間較長時間的諮商與較高的戒菸率並沒有關連(OR 1.08, 95% CI 0.89 to 1.29, 8個試驗)。即使在住院期間開始進行諮商,而在出院後的支持性接觸少於一個月,也沒有顯著的成效(OR 1.09, 95% CI 0.91 to 1.31,6個試驗)。加上尼古丁替代治療(NRT)的戒菸率,並沒有比單獨進行密集性諮商的戒菸率,要有統計上顯著的增加(OR 1.47, 95% CI 0.92 to 2.35, 5個研究)。有一個研究檢驗了在密集諮商之外再加上bupropion,也沒有顯著的增加效果(OR 1.56, 95% CI 0.79 to 3.06)。對於因為心血管疾病(CVD)而住院的吸菸者也有相類似的結果。在這一群次團體中,密集的諮商再加上追蹤的支持增加戒菸率(OR 1.81, 95% CI 1.54 to 2.15, 11個試驗),但較不密集的諮商則沒有效果。有1個研究是對因CVD住院的吸菸者,進行包括諮商與藥物治療的密集治療,評估臨床與健康照護的利用終點,發現在兩年的追蹤期間,各種原因的死亡率以及再住院率都顯著的降低

作者結論

在住院期間開始高密集性的行為治療並包括出院後至少一個月的支持性接觸會促使住院病人戒菸。這些介入是有效的,不論病人的住院診斷為何。密集度較低或時間較短的介入並沒有顯示出成效。沒有足夠的直接證據來支持在密集性諮商加上尼古丁替代療法(NRT)或bupropion,會比單獨進行諮商要增加戒菸率,但在這次的更新中,NRT的療效的證據被強化,而點估計與其他的研究是一致的,顯示NRT與bupropion是有效的

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

在住院期間開始進行戒菸介入處置可協助病人戒菸。吸菸會導致許多健康問題,包括癌症、心血管疾病與肺部疾病。吸菸也會增加因開刀住院的機率。因吸菸相關疾病住院的人會比較願意接受戒菸的協助。我們對研究的回顧發現在住院期間開始戒菸介入處置,且包含出院後至少一個月的追蹤支持是有效的。這樣的治療對於所有住院的吸菸者都是有效的,不論住院診斷為何,也包括因為心血管疾病住院的吸菸者