2008 A Retrospective Analysis of a Smoking Cessation Program in a Local Chest Hospital
Dr Grace Law Tse Sam
Department of Medicine, Kwong Wah Hospital
Objectives: To compare the effectiveness of counseling alone and combination therapy (counseling and pharmacologic agents) in a local in-patient smoking cessation program.
Design: A retrospective analysis of patient data and smoking cessation outcomes
Subjects: All recruited from in-patients of a local chest hospital between Sept 2000 and March 2002 (total 18 months).
Setting: A tuberculosis and chest unit of a hospital in Kowloon West cluster.
Methods: Patients received either counseling alone or combination treatment for smoking cessation. Pharmacologic agents included nicotine replacement (NRT) and bupropion. Smoking status of were assessed at five time points: one week, one month, three months, six months and twelve months.
Outcome Measures: Self reporting system was adopted for smoking status, which was then validated by either exhaled carbon monoxide or by support persons. Success was defined as absolute abstinence from smoking from quit day onwards.
Results: Total 258 patients were recruited: 189 received counseling alone and 69 patients received combination therapy. The overall quitting rate ranged from 41.47% to 60.08%. At all time points, higher quitting rates were found in patients receiving counseling only than those on combination treatment (at one week: 65.60% vs. 44.92%, p=0.005; at one month: 60.85% vs. 37.68%, p=0.002; at three months: 56.08% vs. 31.88%, p=0.002; at six months: 49.73% vs. 31.88%, p=0.019; at twelve months: 46.03% vs. 28.98%, p=0.042). No patient required cessation of drugs because of side effects.
Conclusion: Results of this analysis show two major findings: 1) an overall higher quitting rate in both groups than previously published data 2) counseling alone is more effective than combination therapy in smoking cessation at one week, one month, three months, six months and twelve months.
The overall high quitting rates may be explained by: 1) in-patient setting of the program 2) provision of high intensity of counseling 3) use of telephone follow up 4) presence of physical illness 5) possible over-reporting of abstinence rates 6) uneven sex distribution.
Possible reasons accounting for the inferior result of combination treatment in this analysis include: 1) lower NRT dosage prescribed 2) insufficient duration of drug treatment 3) small sample size 4) nature of the analysis 5) difference in patient demographics between the two treatment groups.
