ARC researchers have evaluated a smoking cessation programme for patients admitted to local hospitals in south London. Our research has shown that implementing a tobacco dependence treatment programme for hospital patients who smoke, reduces readmissions and provides significant cost-savings to the NHS. Among patients who are readmitted, the hospital costs were £491k less than the benchmarked equivalent and they spent 275 fewer bed days in hospital. The report of our findings has given commissioners confidence that the Ottawa Model for Smoking Cessation (OMSC) produces beneficial patient and cost outcomes. Subsequently, this programme is due to be rolled out across all hospitals in south-east London.
Annually, around half a million admissions to acute hospitals are attributable to tobacco smoking, at an estimated cost of £850m. People who currently smoke or used to smoke also use primary care services and outpatient secondary care services more than those who have never smoked, which costs an additional estimated £1.1bn and £696m, respectively.
ARC researchers have been working collaboratively with local NHS Trusts and commissioners for several years to establish tobacco dependence treatment pathways in hospital settings – for example, conducting local audits of delivery and outcomes of limited tobacco dependence treatment and supporting the business case to secure funding from local authorities. Prior to the ARC, our work with local acute NHS Trusts was unfunded and ad hoc. Funding and support from NIHR ARC South London has enabled us to undertake a more substantial robust evaluation.
The Ottawa Model for Smoking Cessation (OMSC) is a targeted intervention for tobacco smokers which is provided during their hospital admission and for six months after discharge. Our evaluation of a one-year trial implementation of OMSC in King’s College Hospital (KCH) and Guy’s and St Thomas’ NHS Foundation Trust (GSTT) found that among 2,084 patients identified as smokers, the quit rate was 7.8% 180 days after discharge (16% in KCH where hospital stays were significantly longer and 3% in GSTT).
A range of clinical and demographic patient characteristics were analysed to identify the profile of patients for whom further targeted intervention may be required, including:
Working with the Head of Costings in King’s College Hospital (KCH), we were able to demonstrate overall;
We have also highlighted where health inequalities exist, where improvements in care can be made and which subgroups of patients may need additional targeted care (particularly for patients of Mixed, Asian, or Other ethnicity, patients with a history of cardiovascular disease, diabetes or a mental health condition).
Differential outcomes were associated with different physical health conditions. For example, patients with diabetes were less likely to accept the intervention than those without, but among those who did accept the intervention, odds of successfully quitting at 90 and 180 days were higher than those without diabetes. The evaluation also emphasises the importance of targeting patients with mental illness, given that 65.6% of patients had a history of mental illness - higher than in previously published studies. Among this group, quit rates were lower at 90 days after discharge, and odds of death or readmission were higher in the year after discharge.
Our evaluation findings of the Ottawa Model for Smoking Cessation (OMSC) have indicated patient subgroups for whom further support may be required to engage with the tobacco dependence treatment and successfully quit smoking. We have also been able to demonstrate that implementing the intervention provides a cost saving through lower readmissions and fewer incurred bed days. The report of our findings has given commissioners confidence that the OMSC produces beneficial patient and cost outcomes. Subsequently, OMSC is due to be rolled out across all hospitals in south-east London.
The profile of patient outcomes identified by our research provides new evidence that will inform the development and funding of targeted tobacco cessation interventions in hospital. This will benefit patient groups most in need, and in doing so, provide benefit to hospital through reduced bed days and readmissions
We have shared the findings of our research with senior leaders at Guy’s and St Thomas’ and King’s College Hospital, as well as the South-East London Tobacco Oversight and Delivery Group and the public involvement groups at ARC South London’s public involvement theme.
We plan to conduct further analyses to enrich our knowledge of the profile of patients most in need of further intervention, for example, through further interrogation of the specific mental health diagnoses associated with poorer outcomes. We will also continue to work with both NHS Trusts to develop and pilot subgroup-specific interventions, with the aim of reducing the identified inequalities.