Motivational counselling with proactive referral increased smoking cessation program participation to 42% vs 9% for brief advice, while older age, living alone, and low education reduced uptake.
RCT (n=280)
1:1
Yes
Does in-hospital motivational counselling with proactive referral improve participation in a municipal smoking cessation programme, and what are the predictors of participation among patients hospitalised for atherosclerotic cardiovascular disease?
Proactive referral to a municipal smoking cessation program significantly increases participation compared to brief advice, though older, less educated, and socially isolated patients remain less likely to participate and may require targeted strategies.
Absolute Event Rate: 42% vs 9%
Abstract Introduction Few patients with atherosclerotic vascular disease attend hospital-based cardiac rehabilitation, and alternative models have been called for (1). Municipal Healthy Life Centres (HLCs) in Norway provide evidence-based lifestyle support, including smoking cessation programmes. We have recently demonstrated that a single in-hospital motivational counselling session with proactive referral to a HLC programme resulted in a higher programme uptake and doubled long-term cessation rates (25% to 50%) (2,3). Purpose To identify patient- and healthcare system factors associated with participation in a municipal cessation programme among patients hospitalised with atherosclerotic vascular disease included in a smoking cessation trial. Methods A pre-specified analysis of two smoking cessation intervention trials conducted from 2021 to 2024. Patients who smoked daily at hospital admission for an atherosclerotic vascular event were randomised 1:1 to in-hospital motivational counselling session combined with proactive referral to the HLC cessation programme (intervention) or to brief advice and written information about the HLC programme (control). Study data were collected from medical records at hospitals and HLCs and from self-report questionnaires. Associations between patient- and healthcare system factors and programme participation were estimated with logistic regression. Results Among 280 randomised patients, mean age was 65 years (SD 10), and 39% were women. Myocardial infarction was the most prevalent cause of hospitalisation (36%) followed by peripheral artery disease (18%) and cerebrovascular disease (14%). At six months 268 patients were available for analysis, excluding two who withdrew consent and ten who had died. Participation in the municipal smoking cessation programme was 42% (56/134) in the intervention group versus 9% (12/134) in the control group. In adjusted analyses of the total population, living with a smoking partner was positively associated with participation at the HLC (odds ratio 2.6) (Table 1). Factors inversely associated with HLC participation were older age (OR 0.7 per 10 years), living alone (OR 0.3), and low education (OR 0.4). Readiness for cessation and psychological distress were not significantly associated with participation. No healthcare system factor reached statistical significance, although inclusion during the summer holiday period appeared to reduce participation. Analysis of the intervention group (N=134) showed comparable results (Table 2). Conclusions Participation in a municipal smoking cessation programme among hospitalised patients with atherosclerotic vascular disease included in the trial was suboptimal, despite proactive referral. Older patients, those living alone, and those with lower education were less likely to participate, highlighting groups that need targeted referral strategies and tailored support to improve the participation rate.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.
Getz et al. (Mon,) conducted a rct in Atherosclerotic vascular disease (n=280). In-hospital motivational counselling session combined with proactive referral to the HLC cessation programme vs. Brief advice and written information about the HLC programme was evaluated on Participation in the municipal smoking cessation programme. Motivational counselling with proactive referral increased smoking cessation program participation to 42% vs 9% for brief advice, while older age, living alone, and low education reduced uptake.