Introduction
Over a quarter of adults smoke, increasing to 40% in deprived areas. Smoking is the largest single cause of preventable, serious ill health and premature death in Britain and increases NHS costs. Admission to hospital, especially with a smoking-related illness, may increase receptiveness and can be a strong motivating factor to stop smoking. Patients who smoke should be offered specialist support (1). Longer follow-up increases stop rates.
A pharmacist-led stop-smoking service has been available in this inner-city hospital for six years. This work assessed the feasibility of referring patients to community pharmacists for extra follow-up after hospital pharmacist care.

Methods
Data were collected from February 2004 to October 2005. The three local primary care trusts (PCTs) were informed and local community pharmacists were recruited.
Inpatient smokers were identified during drug history taking on wards and desire to stop ascertained. Nurses also referred patients. Only patients living locally were asked to participate in the study. Patients were randomised to usual care: in-depth advice, written information and nicotine replacement therapy (NRT) then four weeks hospital pharmacist telephone follow-up; or extra care: same plus referral to community pharmacist for four weeks extra follow-up. Randomisation was higher in the extra follow-up group to assess feasibility of the collaborative service. Extra follow-up patients chose a community pharmacy and were given a referral letter.
Patients were telephoned and sent a questionnaire at 10 weeks. Data collection is ongoing.

Results
Of 718 patients referred, 318 (44%) wanted to stop and agreed a date for stopping smoking, 208 (29%) wanted only basic advice and no follow-up, 125 (17%) were discharged before being seen and 67 (9%) did not want to stop smoking.
Nicotine replacement patches were prescribed for 180/318 (57%) patients agreeing a stop date, other nicotine replacement for 95 (30%) and nothing for 43 (14%) patients.
One-third (199/318, 37%) were not local so were not randomised, 69 (58%) these stopped smoking after four weeks hospital follow-up. In 119 recruited patients, stop rates at four weeks were 12/33 (36%) for usual care and 32/86 (37%) for extra follow-up and NRT. Stop rates were 4/19 (21%) and 23/57 (40%) at ten weeks respectively (p=0.1). Although the service was feasible, few patients said they visited the community pharmacy.

Discussion
Despite a recent health scare causing admission to hospital and availability of stop-smoking support, under half patients wished to stop and the success rate at four weeks is low.
Rates of stopping smoking at four weeks were higher in non-study patients. These are mainly tertiary referrals e.g. cardiac procedures. Cardiac patients are more likely to stop smoking than respiratory disease patients (2) and deprived areas have higher numbers of very addicted smokers which may account for the low stop rate at four weeks in study patients.