Offering smokers admitted to hospital behavioural support and pharmaco- therapy could help reduce smoking rates significantly, a national audit has shown.

A year’s data, from April 2010 to March 2011, was extracted for more than half a million (551,320) patients aged over 15 registered with GP surgeries in England that contribute to The Health Improvement Network.

Combining this data with linked hospital episode data the researchers identified how many smokers had a finished consultant episode (FCE) during the study year.

Within the study population there were 172,537 FCEs delivered over 151,342 inpatient episodes. Smoking status was known for 74% of these patients and for 61% of those who did not have an FCE.

The prevalence of current  and former smoking was higher in those patients who had a consultant episode compared with those who did not. Of patients with no FCE in the study year, 14.7% were current and 19.8% former smokers while for those with at least one FCE the figures were 17.0% and 30.2%, respectively. Overall one in six patients admitted to hospital was a current smoker.

The prevalence of current or former smoking was similar across most hospital specialties but was highest in those treated for mental illness. The prevalence of current smoking for those with mental illness at around 50% was more than double that for other specialties.

Smoking is the biggest avoidable cause of illness and death in the UK. Yet despite the high priority given to the delivery of smoking cessation interventions, the proportion of smokers who receive treatment in the UK remains low, and is falling.

Extrapolation of the data to the whole of England would suggest that around 2.6 million episodes of inpatient care are undergone by approximately 1.1 million smokers each year.

In 2013, NICE recommended routine and systematic delivery of smoking cessation support to smokers using secondary care.1 However, up to now, the prevalence of smoking among patients using hospital services, and therefore the number who might benefit, was unknown.

The authors conclude that their findings ‘indicate that default provision of behavioural support and pharmacotherapy to smokers treated as inpatients in English hospitals has the potential to reach 1.1 million smokers each year. NICE data indicate that this approach is cost effective for both hospitals and wider society.’

Extending this to outpatients would further increase the number of smokers reached, they add.

Dr Jez Thompson