A mixed methods evaluation of an in-reach secondary care tobacco dependency treatment service using the Reach, Effectiveness, Adoption, Implementation, Maintenance (REAIM) framework.

Abstract

Introduction: The NHS Long Term Plan requires all hospital inpatients in England to be systematically identified as smokers and offered opt-out tobacco dependency support. We evaluated an in-reach model in which inpatient treatment is initiated in hospital and continued by community Smoking Cessation Services (SCS) after discharge.

Methods: A mixed methods service evaluation was undertaken in two tertiary hospitals using the RE-AIM framework. Quantitative data (October 2022–February 2023) were extracted from the National Tobacco Dependency Services Dashboard and local SCS systems. Semi-structured interviews were conducted with stakeholders and tobacco dependency advisers, and telephone feedback was obtained from patients.

Results: Of 29,565 inpatients with recorded smoking status, 3,615 (12.2%) smoked and were referred on an opt-out basis; 1,140 (31.5%) were seen by the in-reach team. Of those seen, 955 (83.8%) accepted transfer to community SCS. Among 326 patients who set a quit date, 65.6% self-reported quitting at 4 weeks and 57.9% of these remained quit at 12 weeks. Interviewees identified strong clinical leadership, dedicated advisers and tailored training as key facilitators. Barriers included limited adviser capacity, weekday-only cover, fragmented information technology systems, variable access to nicotine replacement therapy and uncertainty about long-term funding. Patients generally viewed the service as helpful.

Conclusion: An in-reach, opt-out tobacco dependency treatment model linking secondary care with established community services is feasible and can achieve encouraging short-term quit outcomes. Future refinement should focus on strengthening IT infrastructure, staffing capacity, training and secure funding to support wider scale-up and sustainability.