Smoking Cessation Policies & Emergency Department Visits: What’s the Connection?

What impact does a smoking cessation policy have on visits to an emergency room?  This is the question CAMH’s Dr. Paul Kurdyak examined in his paper The Impact of a Smoking Cessation Policy on Visits to a Psychiatric Emergency Department, published in the November 2008 issue of the Canadian Journal of Psychiatry.

Smoking cessation policies are an important part of healthcare, explains Dr. Kurdyak, head of the Emergency Crisis Services and section head of the Centralized Assessment, Triage and Support research unit.  “We know that individuals with mental illnesses are twice as likely to smoke, so we understand the positive outcomes of smoking cessation policies. But, it’s also important to look at potential negative outcomes.”

Working with a team of CAMH scientists, Dr. Kurdyak measured the impact of two smoking cessation polices on weekly visit rates to CAMH’s emergency room; the CAMH policy implemented September 21, 2005 and the Smoke-Free Ontario Act implemented May 31, 2006.  The CAMH team also assessed the impact of these two policies on emergency department visit rates across three broad diagnostic categories: substance-related disorders, psychotic disorders and other disorders, such as depression and bipolar disorder.

Dr. Kurdyak and his team analyzed administrative data from March 1, 2002 to December 31, 2006.  During this time, there were 20,736 visits to CAMH’s emergency department, of which 5,569 were due to psychotic disorders, 2,291 were due to substance use disorders and 12,876 were other disorders.

The data showed that neither the CAMH-specific nor the province-wide smoking cessation policies reduced the overall number of visits to the emergency department.  However, the Smoke-Free Ontario Act had a significant impact on the number of emergency department visits for patients diagnosed with a psychotic disorder, resulting in a 15 percent decrease in hospital visits. 

While work is need to evaluate the impact of smoking cessation polices over a longer period of time, this work does open the discussion about the pros and cons of policies in psychiatric facilities.  “We need to balance the benefits of smoking cessation policies with the potential for these polices to act as a barrier to care, particularly to patients with psychotic illnesses who are in crisis,” says Dr. Kurdyak.

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