Evaluation of a hospital-initiated tobacco dependence treatment service: uptake, smoking cessation, readmission and mortality

BACKGROUND

The National Health Service in England aims to implement tobacco dependency treatment services in all hospitals by 2024. We aimed to assess the uptake of a new service, adapted from the Ottawa Model of Smoking Cessation, and its impact on 6-month quit rates and readmission or death at 1-year follow-up.

METHODS

We conducted a pragmatic service evaluation of a tobacco dependency service implemented among 2067 patients who smoked who were admitted to 2 acute hospitals in London, England, over a 12-month period from July 2020. The intervention consisted of the systematic identification of smoking status, automatic referral to tobacco dependence specialists, provision of pharmacotherapy and behavioural support throughout the hospital stay, and telephone support for 6 months after discharge. The outcomes were (i) patient acceptance of the intervention during admission, (ii) quit success at 6 months after discharge, (iii) death, or (iv) readmission up to 1 year following discharge. Multivariable logistic regression was used to estimate the impact of a range of clinical and demographic variables on these outcomes.

RESULTS

The majority (79.4%) of patients accepted support at the first assessment. Six months after discharge, 35.1% of successfully contacted patients reported having quit smoking. After adjustment, odds of accepting support were 51-61% higher among patients of all non-White ethnicity groups, relative to White patients, but patients of Mixed, Asian, or Other ethnicities had decreased odds of quit success (adjusted odds ratio (AOR) = 0.32, 95%CI = 0.15-0.66). Decreased odds of accepting support were associated with a diagnosis of cardiovascular disease or diabetes; however, diabetes was associated with increased odds of quit success (AOR = 1.88, 95%CI = 1.17-3.04). Intention to make a quit attempt was associated with a threefold increase in odds of quit success, and 60% lower odds of death, compared to patients who did not intend to quit. A mental health diagnosis was associated with an 84% increase in the odds of dying within 12 months.

CONCLUSIONS

The overall quit rates were similar to results from Ottawa models implemented elsewhere, although outcomes varied by site. Outcomes also varied according to patient demographics and diagnoses, suggesting personalised and culturally tailored interventions may be needed to optimise quit success.

Associations of dietetic care and pregnancy outcomes in women with gestational diabetes

Background

Gestational diabetes mellitus (GDM) is a significant, global public health problem. Subsequent strain on healthcare systems is widespread and multidisciplinary care may be inadequate. We assessed current nutrition management of GDM in a large, metropolitan maternity hospital in Melbourne, Australia and associations between the model of dietetic care and maternal and neonatal health outcomes.

Methods

Hospital medical record data from The Women’s Hospital, Melbourne for women with GDM (n = 1,185) (July 2105-May 2017) was retrospectively analysed. Adjusted linear and logistic regression were used to assess associations between the number of dietitian consultations and maternal and neonatal health outcomes.

Results

Half of all women received two consultations with a dietitian. Nineteen percent of women received three or more consultations and of these women, almost twice as many were managed by medical nutrition therapy (MNT) and pharmacotherapy (66%) compared with MNT alone (34%). Odds of maternal complications increased with number of consultations (p = 0.008). Lower odds of infant admission to the Neonatal Intensive Care Unit were observed among women receiving one (OR = 0.38 [95% CI: 0.18, 0.78], p = 0.008), two (OR = 0.37 [95% CI: 15 0.19, 0.71], p = 0.003), or three+ dietitian consultations (OR = 0.43 [95% CI: 0.21, 0.88], p = 0.020), compared to no consultations.

Conclusions

The optimal schedule of dietitian consultations for women with GDM in Australia is unclear. Alternative delivery of nutrition education for women with GDM such as telehealth and utilisation of technology may assist in relieving public health and healthcare system pressures and ensure optimal pregnancy outcomes.

Key messages

• Delivering medical nutrition therapy through individual consultations does not deliver a linear benefit to women with GDM and their offspring.

• Alternative delivery modes are needed to optimise outcomes for healthcare services and their patients.

The impact of COVID-19 on smoking cessation in pregnancy

OBJECTIVES

A greater proportion of non-pregnant smokers attempted to stop smoking during compared to before the COVID-19 pandemic. The objective of this study was to determine if a greater proportion of pregnant women also attempted to stop smoking during the pandemic rather than before.

METHODS

The use of antenatal smoking cessation services and nicotine replacement therapies (NRT) in pregnant women was audited before (2019-2020) and during the COVID pandemic (2020-2021). Anonymised data from January 2019 to March 2021 were analysed from the Lambeth and Southwark smoking cessation service.

RESULTS

A total of 252 pregnant women who smoked were referred to their local antenatal smoking cessation service, of which 90 (35.7%) (median age: 31 years [19-52 years]) chose to attend smoking cessation clinics. The COVID-19 pandemic was not associated with an increase in the number of women attending smoking cessation clinics, (2020-2021 n=46 [40.8%] of 110); compared to (2019-2020 n=44 [30.9%] of 142 referred pregnant women pre-pandemic) p=0.061. Eighty-two women utilised NRT to help them stop smoking and the frequency of NRT use did not change during the pandemic (2019-2020 n=39, 2020-2021 n=43; p=0.420). No significant difference in smoking cessation rates between the two periods was observed at either the four-week (p=0.285) or twelve-week follow-up (p=0.829).

CONCLUSIONS

Smoking cessation rates in pregnant women and the demand for antenatal smoking cessation services was unchanged during compared to before the COVID-19 pandemic.

Associations of dietetic management with maternal and neonatal health outcomes in women diagnosed with gestational diabetes: a retrospective cohort study

BACKGROUND

In 2010, the recommended diagnostic thresholds for gestational diabetes mellitus (GDM) were amended, which has increased GDM diagnoses, as well as pressure on the services involved in GDM management, specifically impacting dietetic workloads. The present study examined the associations between dietetic intervention in women with GDM and maternal and neonatal health outcomes.

METHODS

The present study involved 1233 adult women with GDM who delivered at The Royal Women's Hospital (RWH), Melbourne, Australia, between July 2015 and May 2017. Retrospective data assessing GDM-care (therapy type, diagnosis time and model of care, maternal and neonatal health outcomes, and outpatient dietetic consultations) were retrieved from patient medical records. Unadjusted and adjusted linear and logistic regression were used to assess associations of GDM care dietetic intervention and GDM care and dietetic intervention with maternal and neonatal health outcomes.

RESULTS

Women receiving dietetic intervention had a decreased likelihood of infant admission to the neonatal intensive care unit or special care nursery than women who not receiving dietetic intervention [adjusted odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.22-0.75; P = 0.004). Women requiring pharmacotherapy were more likely to experience maternal complications (adjusted OR = 3.13, 95% CI = 2.23-4.41; P < 0.001) and had a greater number of dietetic consultations (β-coefficient = 0.28, 95% CI = 0.17-0.39; P < 0.001) compared to women managed through diet.

CONCLUSIONS

Dietetic intervention plays a key role in optimising maternal and neonatal health outcomes for women with GDM. Exploring further the impact of dietetic intervention in women diagnosed with GDM is key with respect to understanding the optimal delivery of care for these women. The type and number of consultations included in a dietetic intervention should be investigated further.

Smoking cessation interventions for COPD: a review of the literature

The aim of this systematic review is to establish the most effective stop smoking intervention approach for smokers with COPD. The search strategy included the electronic databases MEDLINE, EMBASE, AMED, PsycINFO, DARE, Cochrane Library, and CINAHL, between January 2006 and January 2010. References of the included studies were also screened for additional papers, and further hand searches were conducted. The selection criteria included randomized controlled trials or quasi-randomized controlled trials with at least one subject group diagnosed with COPD. Two independent reviewers reviewed the included studies, using a quality assessment form developed from the selection criteria. Divergence of quality assessment scores was resolved by the 2 reviewers agreeing on a score. The 4 studies selected indicate that psychosocial interventions combined with pharmacotherapy are effective in smoking cessation at 12 months post-intervention, although the effect is not statistically significant, due to small sample size and heterogeneity between the studies (odds ratio 2.35, 95% CI 0.25-21.74,). However, despite this medium effect size, due to a lack of universal use of pharmacotherapies in most of the studies, it makes a definitive comparison of efficacy difficult to determine. This review also shows the effectiveness of psychosocial treatment for people with or without COPD symptoms at 12 months, although the effect of disease severity is not clear. This review also highlights the difficulty of maintaining attendance at community-based locations, compared to acute or research settings.