Smoking cessation after referral from hospital to community stop smoking services: an observational study

Introduction: In England, acute National Health Service (NHS) hospitals routinely ask patients about smoking status on admission, offering in-hospital treatment for tobacco dependence and support for quitting postdischarge. Referring patients to community stop smoking services (CSSS), which offer behavioural and pharmacological support postdischarge, is a key strategy for this continued support. This study investigated the patient flows from hospital to CSSS and the subsequent quitting outcomes.

Methods: This study was part of an evaluation of a hospital tobacco dependence treatment service in South Yorkshire, England. The primary data source was electronic record data from one CSSS that received hospital referrals. Data were from July 2021 to March 2023, covering the initial phase of hospital service implementation. We described patient flows from hospital referral through to the 4-week self-reported quitting outcomes recorded by the CSSS. Generalised linear models explored associations between 4-week abstinence and patient characteristics including demographics, socioeconomic status, nicotine dependence and health factors.

Results: Of 3223 hospital referrals, 72.0% (2322) could be contacted by the CSSS, 52.5% (1692) then registered, 41.4% (1333) made a CSSS-supported quit attempt and 25.3% (815) self-reported abstinence from smoking 4 weeks later. The analysis highlighted lower quitting success for people receiving free NHS prescriptions—an indicator of health and/or socioeconomic vulnerability (OR 0.54, 95% CI 0.32 to 0.90) and with high nicotine dependence (OR 0.57, 95% CI 0.37 to 0.87). Higher quitting success was found for people who reported having cancer (OR 2.26, 95% CI 1.18 to 4.32), but otherwise, there were no significant influences of the health factors investigated.

Conclusions: The substantial drop-out between hospital referral to CSSS and receiving their support for quit attempts is a key area for hospital and CSSS service improvement. The strong quitting success among people with cancer underscores the potential benefits of improved care transfer for vulnerable patient groups.