Smoking Termination Opportunity for inPatients (STOP)

• Smoking abstinence [ Time Frame: one year ] [ Designated as safety issue: Yes ]
  Continued smoking abstinence is defined as: less than or equal to no more than 5 cigarettes smoked during the period of 2 weeks to 12 months post enrollment.
  
  

• Reduced hospital bed utilisation [ Time Frame: one year ] [ Designated as safety issue: No ]
  Hospital casemix/DRG data will be collected for the 5 years prior to enrollment and one year post enrollment. This will be supplemented by SA Department of Health data and PBS/MBS data sets of study completion, to monitor admissions at other hospitals and GP visits.
  
  
• 7-day point prevalence [ Time Frame: from 2 weeks to 3 months post enrollment ] [ Designated as safety issue: Yes ]
  Defined as no cigarettes for the previous 7 days
  
  
• Reduction in health care costs [ Time Frame: one year ] [ Designated as safety issue: No ]
  Reduced health care costs with greater economic value will be relative to other health interventions. Four seperate economic models will be built for vascular diseases: cardiovascular, cerebrovascular and peripheral vascular diseases and airways diseases: asthma and/or chronic obstructive pulmonary disease. Each model will compare outcomes and costs for varenicline and counselling compared to counselling alone, and will incorporate epidemiological data on natural disease progression of smokers and previous smokers from the four disease profiles split by gender if indicated.
  
  
• Inpatient craving levels [ Time Frame: baseline to end of inpatient stay ] [ Designated as safety issue: No ]
  Craving scales will be used to assess levels during inpatient stay (pre and post intervention delivery)
  
  
• Prevalence of inpatient smoking [ Time Frame: From baseline to end of inpatient stay ] [ Designated as safety issue: Yes ]
  Measured by self-report and observation by hospital and study staff prior to discharge.
  
  

A national standard in public hospitals for the management of smoking in patients admitted with smoking related acute illnesses is lacking. Where such patients have continued to smoke up until the time of admission, it can be assumed that "primary" prevention has failed.

Once admitted, there is a vastly under-utilised opportunity, by use of a structured and systematic approach, to intervene with a secondary prevention attempt. This takes advantage of the synergy of:

1. the smoker is a "captive audience" and may be receptive to considering lifestyle factors that have lead to the admission, and
2. best practice medication and counselling can be initiated prior to discharge. If proven to be cost-effective in our analysis, a systematic roll-out of this secondary prevention initiative would be advocated. ie translation of research into practice.