Smoking Cessation after Transitioning from Hospital to Community Stop Smoking Services: Insights from Real-world Data Analysis

Abstract

Background Patients seen by National Health Service (NHS) hospitals in England should now be asked if they smoke on admission. People who smoke should be treated for tobacco dependence in hospital, then offered support to quit outside of hospital. One way to support post-hospital quitting is through referring patients to community stop smoking services (CSSS). In 2024, the government announced a doubling of CSSS funding for five-years to improve reach and outcomes. Our study aimed to describe the quit rates of people referred from hospital to CSSS, alongside investigating individual characteristics associated with quitting success to inform the potential for more cost-effective, targeted support in the future. Methods The study was part of a service evaluation using real-world data collected via a CSSS electronic record system in England, which received referrals from hospital-based tobacco teams. We compared CSSS activity and quitting outcomes to local and national reporting data. Generalised Linear Models were used to investigate quitting outcomes 4-weeks after baseline in relation to demographic, socio-economic, nicotine dependence, intervention, and health factors hypothesised to be associated with quitting outcomes. Results Hospital-referred patients comprised 26% of CSSS referrals, tended to be older, with lower socio-economic status and more long-term health conditions. Overall quitting success by people who made a CSSS supported quit attempt was 61% at 4-weeks, slightly lower than local averages, but similar to national averages. Our analysis sample contained records of 1,326 quit attempts that were supported by CSSS. Of the variables investigated, we found that receiving free NHS prescriptions was consistently associated with lower quitting success (Odds Ratio [OR] 0.55, 95% Confidence Interval [CI] 0.33-0.92), potentially because this is a proxy for lower socio-economic and health status. After accounting for other factors, having cancer relative to no health conditions was associated with higher quitting success (OR 2.26, 95%CI 1.18-4.33). Conclusion Ensuring patients continue seeking support to quit smoking after their interaction with hospital-based services can lead to quit rates comparable to other CSSS attendees who make a quit attempt. Our analyses highlight the importance of hospital and CSSS investment in improving the transfer of care between services.