Evaluating the efficacy of an integrated smoking cessation intervention for mental health patients: study protocol for a randomised controlled trial.

BACKGROUND: Smoking rates, and associated negative health outcomes, are disproportionately high among people with mental illness compared to the general population. Smoke-free policies within mental health hospitals can positively impact on patients' motivation and self-efficacy to address their smoking. However, without post-discharge support, preadmission smoking behaviours typically resume. This protocol describes a randomised controlled trial that aims to assess the efficacy of linking mental health inpatients to community-based smoking cessation supports upon discharge as a means of reducing smoking prevalence. METHODS/DESIGN: Eight hundred participants with acute mental illness will be recruited into the randomised controlled trial whilst inpatients at one of four psychiatric inpatient facilities in the state of New South Wales, Australia. After completing a baseline interview, participants will be randomly allocated to receive either: 'Supported Care', a multimodal smoking cessation intervention; or 'Normal Care', consisting of existing hospital care only. The 'Supported Care' intervention will consist of a brief motivational interview and a package of self-help material for abstaining from smoking whilst in hospital, and, following discharge, 16 weeks of motivational telephone-based counselling, 12 weeks of free nicotine replacement therapy, and a referral to the Quitline. Data will be collected at 1, 6 and 12 months post-discharge via computer-assisted telephone interview. The primary outcomes are abstinence from smoking (7-day point prevalence and prolonged cessation), and secondary outcomes comprise daily cigarette consumption, nicotine dependence, quit attempts, and readiness to change smoking behaviour. DISCUSSION: If shown to be effective, the study will provide evidence in support of systemic changes in the provision of smoking cessation care to patients following discharge from psychiatric inpatient facilities. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZTCN: ACTRN12612001042831. Date registered: 28 September 2012.

An audit of the prevalence of recorded nicotine dependence treatment in an Australian psychiatric hospital.

OBJECTIVES: To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status. METHOD: A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six-month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one-page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD-10-AM diagnoses coding was used. RESULTS: From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0-0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses. CONCLUSIONS: Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder. IMPLICATIONS: Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained.