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Clinicians 'failing to ask 75% of smokers' while in hospital about trying to quit

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More than 25% of patients are not being asked by healthcare professionals if they smoke when they come into hospital in the UK, despite acute services having a higher concentration of people dependant on tobacco than the general population, a respiratory doctor has warned.

In addition, nearly 75% of those patients who say they smoke are not being asked by staff if they would like to quit, according to Dr Sanjay Agrawal, a respiratory physician at University Hospitals of Leicester NHS Trust.

“The hospital population is enriched with smokers… So the problem with tobacco dependence hasn’t gone away”

Sanjay Agrawal

Dr Agrawal, who is also the chair of the British Thoracic Society’s specialist advisory group, jointly led an audit of smoking cessation practices in hospitals between April and May last year. The work involved examining 14,750 patient records at hospitals at 120 NHS trusts.

Presenting the findings at Public Health England’s annual conference this week, he also revealed that only one in 13 patients who smoked were referred to hospital or community-based services to help them stop.

Meanwhile, less than 5% of patients who smoked, but had not been asked about quitting, were given nicotine replacement therapy to help them abstain while in hospital.

A separate audit of policies at the hospitals also revealed 50% of frontline healthcare staff were not offered regular smoking cessation training.

“Treatment of sick smokers in UK hospitals is poor so please don’t assume it is anything but that in your patch”

Sanjay Agrawal

At the same time, three quarters of hospitals had no consultant leading on smoking cessation and half had no dedicated practitioner for tobacco dependence.

“So the biggest single cause of preventable morbidity and mortality doesn’t have a lead. Why aren’t we commissioning leaders for that service in hospital?” Dr Agrawal asked delegates at the PHE conference at the University of Warwick.

Compliance with national standards on smoking cessation was “woefully lacking” he concluded in a report that he has co-written based on the audit.

This was particularly concerning because the findings revealed that among patients aged 16 to 25 years old, 41% were smokers – which was a “much greater” proportion that the overall average for the country, noted Dr Agrawal at the event in Coventry on Tuesday.

“The hospital population is enriched with smokers. So the problem with tobacco dependence hasn’t gone away yet in hospitals,” he warned the audience of public health professionals.

“Treatment of sick smokers in UK hospitals is poor, so please don’t assume it is anything but that in your patch,” he added.

“Language really matters. If you’re going to engage clinicians we need to be talking about tobacco dependence”

Dr Louise Restrick

In the report, Dr Agrawal called for a number of improvements to be made, including for all hospital patients who smoke to be referred to a specialist service, and to also be prescribed nicotine replacement therapy.

A senior clinician should be appointed at every NHS trust to lead a hospital-based smoking cessation service in line with national guidelines, said the report.

Meanwhile, trust boards should be held accountable by UK regulators to enforce smoke-free hospital policies that support attempts at quitting among patients, staff and visitors, it said.

Speaking as part of the same session during the PHE conference, a consultant respiratory physician based in London also made a plea for more training to ensure clinicians could broach the subject of quitting smoking with patients.

Dr Louise Restrick, from Whittington Health NHS Trust, said that based on experiences at her own organisation, frontline staff needed to be taught skills in motivational interviewing conversations and be able to prescribe medication.

Whittington Health NHS Trust

Clinicians ‘failing to ask 75% of smokers in hospital’ about quitting

Louise Restrick

Changes made at her trust had resulted in half of smoker patients with chronic obstructive pulmonary disease quitting within six months of being offered treatment, she said.

She also claimed she “didn’t know a single clinician” who believed that prevention was part of their job and stressed it was, therefore, important to change the language around smoking cessation and instead refer to it as a tobacco dependency that needed to be treated.

“Language really matters. If you’re going to engage clinicians we need to be talking about tobacco dependence, which is a relaxing, remitting long-term condition that starts in childhood,” she Dr Restrick.

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