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Utilisation of Nicotine Replacement Therapy within a Hospital Pharmacist Initiated Smoking-Cessation Intervention – A Pragmatic Randomised Controlled Trial

Published online by Cambridge University Press:  02 October 2015

D. Gupta ,
K. Winckel ,
J. Burrows ,
J. Ross  and
J. W. Upham
D. Gupta*
Affiliation:
Department of Pharmacy, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia School of Pharmacy, The University of Queensland, Woolloongabba, Brisbane, Australia
K. Winckel
Affiliation:
Department of Pharmacy, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia School of Pharmacy, The University of Queensland, Woolloongabba, Brisbane, Australia
J. Burrows
Affiliation:
School of Pharmacy, The University of Queensland, Woolloongabba, Brisbane, Australia
J. Ross
Affiliation:
Department of Pharmacy, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia Respiratory Department, Princess Alexandra Hospital, Brisbane, Australia
J. W. Upham
Affiliation:
Respiratory Department, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, The University of Queensland, Brisbane, Australia
*
Address for correspondence: Deepali Gupta, Clinical Pharmacist, Princess Alexandra Hospital, Woolloongabba, Brisbane-4102. Email: deepali.gupta@health.qld.gov.au
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Abstract

Introduction: Hospital pharmacists currently play a limited role in the management of nicotine withdrawal and smoking-cessation. They have multiple tasks and limited time; a strong evidence base is required to determine importance of including smoking-cessation interventions into their routine practice.

Aims: The aims of this study were to evaluate the effectiveness of a hospital pharmacist initiated smoking-cessation intervention (SCI) in increasing the utilisation of Nicotine Replacement Therapy (NRT) in hospitalised smokers, and in increasing quit rates post-discharge.

Methods: This study was conducted in a tertiary referral hospital using a pragmatic randomised control design. After screening, 100 inpatient smokers were enrolled and randomised by the research pharmacist (RP) to either the intervention or usual care arm (n = 50 for both arms). Smoking-cessation advice was available to all smokers during their hospital stay under the smoking management policy, which represented usual care. However, this approach is often unstructured and provided on an ad-hoc basis. Those in the intervention arm received brief SCI from the RP, who also facilitated NRT prescribing if required. Prescribing rates of NRT in the hospital and on discharge in both the groups were compared. Participants were contacted by phone three-months after enrolment to assess their seven-day point prevalence of abstinence (PPA) from smoking and use of NRT post-discharge.

Results: A significantly higher proportion of participants in the intervention arm used NRT in the hospital (82% vs. 24%, Χ2 = 33.8, p < 0.001) and at discharge (68% vs. 12%, Χ2 = 32.7, p < 0.0001) and significantly more participants who received SCI from the RP continued to use NRT after discharge (OR 3.1, CI 1.2 to 8.2). A similar number of participants in both the groups claimed seven-day PPA after three-months (18% usual-care vs. 15% intervention-arm, OR 0.8, CI 0.24 to 2.67).

Conclusions: Hospital pharmacist led brief SCI can enhance the utilisation of NRT in hospital and after discharge; there was no clear effect on cessation rates at three months. There is a need to explore feasible options for a coordinated, multidisciplinary approach to smoking-cessation in hospital and across the continuum, which may have a greater impact on long term smoking-cessation rates.

Type
Original Articles
Information
Journal of Smoking Cessation , Volume 12 , Issue 1 , March 2017 , pp. 45 - 54
Copyright
Copyright © The Author(s) 2015 

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References

Aveyard, P., Begh, R., Parsons, A., & West, R. (2012). Brief opportunistic smoking cessation interventions: A systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction, 107 (6), 1066–1073. doi: 10.1111/j.1360-0443.2011.03770.x.Google Scholar
Beller, E. M., Gebski, V., & Keech, A. C. (2002). Randomisation in clinical trials. Medical Journal of Australia, 177 (10), 565–567.Google Scholar
Bittoun, R. (2006). Combination NRT algorithm for Hard-to-Treat smokers. Journal Of Smoking Cessation, 1 (1), 3–6.Google Scholar
Bowman, J., & Stockings, E. A. (2012). Smoking cessation for hospitalised patients- Intensive behavioral counselling started in hospital and continued after discharge increases quit rates. Evidence Based Nursing, 16 (1), 21–22.Google Scholar
Chabrol, H., Niezborala, M., Chastan, E., & de Leon, J. (2005). Comparison of the heavy smoking index and of the fagerstrom test for nicotine dependence in a sample of 749 cigarette smokers. Addictive behaviors, 30 (7), 1474–1477. doi: http://dx.doi.org/10.1016/j.addbeh.2005.02.001.Google Scholar
Collins, D., & Lapsley, H. (2008). The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/5. P3–2625. Canberra: Retrieved from: http://www.health.gov.au/internet/drugstrategy/publishing.nsf/Content/34F55AF632F67B70CA2573F60005D42B/$File/mono64.pdf. Accessed 25 February 2015.Google Scholar
Dobrinas, M., Blanc, A.-L., Rouiller, F., Christen, G., Coronado, M., & Tagan, D. et al. (2014). Clinical pharmacist's role in implementing a smoking cessation intervention in a Swiss regional hospital: An exploratory study. International Journal of Clinical Pharmacy, 36 (3), 526–534. doi: 10.1007/s11096-014-9927-8.Google Scholar
Fagerstrom, K. O., & Schneider, N. G. (1989). Measuring nicotine dependence: A review of the fagerstrom tolerance questionnaire. Journal of Behavioral Medicine, 12 (2), 159–182.Google Scholar
Fiore, M. C., McCarthy, D. E., Jackson, T. C., Zehner, M. E., Jorenby, D. E., & Mielke, M. et al. (2004). Integrating smoking cessation treatment into primary care: An effectiveness study. Preventive Medicine, 38 (4), 412–420. doi: 10.1016/j.ypmed.2003.11.002.CrossRefGoogle ScholarPubMed
Freund, M. A., Campbell, E. M., Paul, C. L., Wiggers, J. H., Knight, J. J., & Mitchell, E.N. (2008). Provision of smoking care in NSW hospitals: Opportunities for further enhancement. NSW Public Health Buletin, 19 (3–4), 50–55.Google Scholar
Garcia-Rodriguez, O., Secades-Villa, R., Florez-Salamanca, L., Okuda, M., Liu, S. M., & Blanco, C. (2013). Probability and predictors of relapse to smoking: Results of the National Epidemiologic Survey on Alcohol and Related conditions (NESARC). Drug and Alcohol Dependence, 132 (3), 479–485. doi: 10.1016/j.drugalcdep.2013.03.008.Google Scholar
Gupta, D., Ross, J., & Michael, H. (2012). Drug use evaluation on the use of nicotine replacement therapy (NRT) as a smoking cessation aid in Princess Alexandra Hospital (PAH). Unpublished report compiled as a quality use of medicine placement project submitted as part fulfilment of the undergraduate pharmacy degree (fourth year). The University of Queensland, Brisbane, Australia.Google Scholar
Kasza, K. A., Hyland, A. J., Borland, R., McNeill, A. D., Bansal-Travers, M., & Fix, B.V. et al. (2013). Effectiveness of stop-smoking medications: Findings from the International Tobacco Control (ITC) four country survey. Addiction, 108 (1), 193–202. doi: 10.1111/j.1360-0443.2012.04009.x.CrossRefGoogle ScholarPubMed
Kirby, T. (2009). Australia considers string of preventive health measures. The Lancet, 374 (9694), 963.CrossRefGoogle ScholarPubMed
Kozlowski, L. T., Porter, C. Q., Orleans, C. T., Pope, M. A., & Heatherton, T. (1994). Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI. Drug Alcohol Depend, 34 (3), 211–216. doi: http://dx.doi.org/10.1016/0376-8716(94)90158-9.Google Scholar
Lancaster, T., Stead, L., Silagy, C., & Sowden, A. (2000). Effectiveness of interventions to help people stop smoking: Findings from the cochrane library. Brithish Medical Journal, 321 (7257), 355–358.CrossRefGoogle ScholarPubMed
Lichtenstein, E., & Hollis, J. (1992). Patient referral to a smoking cessation program: Who follows through? The Journal of Family Practice, 34 (6), 739–744.Google Scholar
Mendelsohn, C. (2011). Nicotine dependence: Why is it so hard to quit? Medicine Today, 12 (10), 35–39.Google Scholar
National Preventative Health Taskforce - Tobacco Working Group (2009). Tobacco control in Australia: Making smoking history. Commonwealth of Australia, ACT.Google Scholar
Nides, M. (2008). Update on pharmacologic options for smoking cessation treatment. American Journal of Medicine, 121 (4 Suppl 1), S20–S31. doi: 10.1016/j.amjmed.2008.01.016.CrossRefGoogle ScholarPubMed
Prochaska, J. J., Fletcher, L., Hall, S. E., & Hall, S. M. (2006). Return to smoking following a smoke-free psychiatric hospitalization. American Journal of Addiction, 15 (1), 15–22. doi: 10.1080/10550490500419011.CrossRefGoogle ScholarPubMed
Reid, R. D., Mullen, K.-A., D’Angelo, M.E.S., Aitken, D. A., Papadakis, S., & Haley, P.M. et al. (2010). Smoking cessation for hospitalized smokers: An evaluation of the “Ottawa Model”. Nicotine & Tobacco Research, 12 (1), 11–18. Retrieved from http://ntr.oxfordjournals.org/content/12/1/11.short. Accessed 25 February 2015.Google Scholar
Rice Virginia, H., Hartmann-Boyce, J., & Stead Lindsay, F. (2013). Nursing interventions for smoking cessation. The Cochrane Database of Systematic Reviews, 2013 (8), 1–88. doi: 10.1002/14651858.CD001188.pub4.Google Scholar
Rigotti, N. A. (2012). Strategies to help a smoker who is struggling to quit. JAMA: Journal of the American Medical Association, 308 (15), 1573–1580. doi: 10.1001/jama.2012.13043.Google Scholar
Rigotti, N. A., Clair, C., Munafo, M. R., & Stead, L. F. (2012). Interventions for smoking cessation in hospitalised patients. The Cochrane Database of Systematic Reviews, 2012 (5), 1–85. doi: 10.1002/14651858.CD001837.pub3.Google Scholar
Rigotti, N. A., Regan, S., Levy, D. E., Japuntich, S., Chang, Y., & Park, E. R. et al. (2014). Sustained care intervention and postdischarge smoking cessation among hospitalized adults: A randomized clinical trial. JAMA: Journal of the American Medical Association, 312 (7), 719–728. doi: 10.1001/jama.2014.9237.Google Scholar
Saba, M., Bittoun, R., Kritikos, V., & Saini, B. (2013). Smoking cessation in community pharmacy practice – A clinical information needs analysis. Springerplus, 2, 449. doi: 10.1186/2193-1801-2-449.Google Scholar
Schulz, K. F., Altman, D. G., Moher, D., & Group, C. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMJ: British Medical Journal, 340, c332. doi: 10.1136/bmj. c332.Google Scholar
Stead, L., & Lancaster, T. (2012). Combined pharmacotherapy and behavioural interventions for smoking cessation. The Cochrane Database of Systematic Reviews, 2012 (10), 1–91. doi: 10.1002/14651858.CD008286. pub2.Google Scholar
Stead, L. F., Perera, R., Bullen, C., Mant, D., Hartmann-Boyce, J., Cahill, K., & et al. (2012). Nicotine replacement therapy for smoking cessation. The Cochrane Database of Systematic Reviews, 2012 (11), 1–264. doi: 10.1002/14651858.CD000146.pub4.Google Scholar
Wolfenden, L., Campbell, E., Walsh, R., & Wiggers, J. (2003). Smoking cessation interventions for in-patients: A selective review with recommendations for hospital-based health professionals. Drug Alcohol Review, 22 (4), 437–452. doi: 10.1080/09595230310001613967.Google Scholar
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