Smoking cessation interventions in the pre-admission clinic: assessing two approaches

Brief intervention (BI) to encourage patients who smoke to quit is effective and should occur at every patient interaction. If smokers receive a motivational interview in addition to BI and are offered pharmacotherapy to treat nicotine withdrawal, cessation rates may be improved. We compared the uptake, implementation, and effectiveness of these two approaches in the delivery of a smoking cessation intervention during assessments in a pre-admission clinic (PAC).

The study was performed in the PAC at two tertiary care hospitals. At both hospitals, PAC patients were screened for smoking status, and current smokers were offered the opportunity to participate in a cessation program. Those who agreed were asked to consent to participate in an evaluation of program effectiveness that included a telephone interview about smoking status six months after hospital discharge. A cohort design was used to compare cessation outcomes across PACs during a one-year period of patient recruitment. The primary outcome measure was a self-reported continuous quit rate six months following hospitalization. Secondary outcomes included the number of patients willing to participate and the completeness of the delivery of program components.

A BI delivered at one PAC consisted of brief advice and self-help materials, including handing the patient a business card with an available 1-800 Quit line (a telephone smoking cessation help line). The other PAC offered an intensive intervention (II) that included augmenting the BI with an in-hospital and post-discharge motivational interview and access to nicotine replacement therapy (NRT) during admission.

At follow-up, we were able to contact 147 of the 288 smokers who agreed to participate in the evaluation of the program, and the self-reported quit rates for the BI and II interventions were 11.4% and 19.5%, respectively. More than 1,200 current smokers were identified and approached at both PACs during the 12-month patient recruitment period, and 60% of those were willing to accept the offered smoking cessation intervention (either BI or II). Implementation of II was uneven, particularly the delivery of the in-hospital motivational interview and prescription of NRT. Uptake of the 1-800 Quit service after discharge was inadequate.

The PAC is a feasible location to identify smokers and offer a cessation intervention. There are considerable logistical barriers to the development of an II intervention program as described. A program that incorporates elements of BI and II could offer a practical approach to the implementation of a hospital-wide smoking cessation intervention.