Can smokers switch from a hospital-based to a community-based stop smoking service? an open-label, randomized trial comparing three referral schemes.

ABSTRACT

INTRODUCTION: Many hospitals advise their smoking patients to contact a community-based stop smoking service. We investigated how well smokers attend a community-based service after receiving help from a hospital smoking cessation specialist (HSCS). METHODS: In this 55-week, single-blinded trial, 450 consecutive smokers, attending two U.K. hospitals, were randomized. Group A received a brief intervention consisting of a 20-min consultation from an HSCS and leaflets with contact information for their community-based service. Group B received a 60-min consultation, four weekly appointments with the HSCS, and leaflets with contact information for their community-based service. Group C received a 60-min consultation and four weekly appointments with the HSCS and then agreed to attend a scheduled appointment at the nearest community-based service within 1 week. Pharmacotherapy was recommended to all participants, and they were advised to attend the community-based service for ongoing support immediately and at Weeks 5, 12, 26, and 52. At 55 weeks, the HSCS contacted participants again, without warning, for validation. RESULTS: Community-based service attendance at 5 weeks was 7% in Group A, 4% in Group B, and 23% in Group C (p < .001). Over 12-26 weeks, rates of community-based service attendance were 6%-12% in all groups. These rates remained consistently higher in Group C (p < .05) but fell throughout the period to only 3%, 5%, and 7%, respectively, at 52 weeks (p = .26). HSCS attendance at 55 weeks and point prevalence, validated quit rates were 17% for Group A, 20% for Group B, and 22% for Group C (p = .75). DISCUSSION: A specific appointment improves immediate and medium-term attendance at the community-based service, but hospitalized smokers do not switch well to a community-based service following any referral strategy. However, a significant proportion made a repeat visit to the hospital-based program much later on.