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NHS hospitals must help patients quit smoking, says British Thoracic Society

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6571 (Published 07 December 2016) Cite this as: BMJ 2016;355:i6571

Hospitals and smoking cessation: worldwide malpractice!

Torjesen highlighted the warning from the British Thoracic Society, “NHS hospitals around the UK are not meeting national standards on helping patients to quit smoking and are not enforcing smoke-free premises.”(1) Davies, the chair of the British Thoracic Society board, rightly claims, “being admitted to hospital should be a real window of opportunity for smokers to quit … expert stop smoking advice and therapies” and called for a “fund and plan” but they can hardly be the solution.(1)

First, only one-half of patients with cancer who smoke are counselled to quit, although cessation is an important factor in the outcome (cancer treatment effectiveness, overall survival, risk of second primary malignancies, and quality of life).(2) For patients with coronary disease the first EUROASPIRE survey was performed in 1995-96, the fourth round showed no improvement, 49% of those smoking at the time of the event are persistent smokers.(3) For pregnant women, despite smoking being the most preventable cause of preterm birth and other complications, the treatment is inadequate.(4)

Second, the plan is useless. In the US, in 2012 the Joint Commission aimed to move forward for quality with the Cessation Performance Measure-Set (TOB) and proposed to hospitals the documentation of a fourth item: the tobacco-use status 30 days after discharge (TOB-4).(5) The first results were for 2014: only 68 hospitals chose to report data about TOB, the score being 36.4% for TOB-3 (the referral at discharge for evidence-based cessation counselling and a prescription for cessation medication) (see table 14 of the report http://www.jointcommission.org/annualreport.aspx). For 2015 there will be 671 hospitals for TOB vs an average of 3,254 hospitals reporting data for other disciplines. As in 2014, there will be no TOB-4 data for 2015. Data collection was suspended for TOB-4 due to the “inability for hospitals to document follow-up information” after patients left the hospitals! How after discharge can monitoring results of treatment to adapt them or to improve compliance be a lesser concern than billing procedures?

We must call a spade a spade. Malpractice suits could be the sole solution to improve quality of care for smoking cessation. Why should funding and a plan be prerequisites for motivational interviewing and prescription of a combination of nicotine replacement therapy (patch + oral) or varenicline?

1 Torjesen I. NHS hospitals must help patients quit smoking, says British Thoracic Society. BMJ 2016;355:i6571
2 Ramaswamy AT, Toll BA, Chagpar AB, Judson BL. Smoking, cessation, and cessation counseling in patients with cancer: A population-based analysis. Cancer 2016. Online Feb 16. doi: 10.1002/cncr.29851.
3 Kotseva K, Wood D, De Bacquer D et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol 2016 Apr;23(6):636-48
4 Braillon A, Bewley S. Behavioral Counseling and pharmacotherapy interventions for tobacco cessation in pregnant women. Ann Intern Med 2016;164:637.
5 Fiore MC, Goplerud E, Schroeder SA. The Joint Commission's new tobacco-cessation measures--will hospitals do the right thing? N Engl J Med 2012;366:1172-4.

Competing interests: No competing interests

13 December 2016
alain braillon
senior consultant
University Hospital. 80000 Amiens. France