Research ArticlesThe use of nicotine-replacement therapy by hospitalized smokers1
Introduction
United States hospitals are now required to have no-smoking policies in order to be accredited.1, 2 Therefore, a hospital stay requires a smoker to abstain temporarily from tobacco. This offers hospitalized smokers an opportunity to initiate cessation, but it can also precipitate nicotine-withdrawal symptoms in hospitalized smokers, causing discomfort and reducing smokers’ compliance with no-smoking policies.3, 4, 5 Nicotine-replacement therapy (NRT) is an effective smoking-cessation treatment that reduces the symptoms of nicotine withdrawal.6, 7 Nicotine-replacement therapy offers hospitalized smokers a way to reduce the discomfort of nicotine withdrawal in the hospital and increase the chance of remaining abstinent from tobacco after discharge.
Smoking-cessation clinical practice guidelines from the Agency for Health Care Policy and Research (AHCPR) recommend that hospitalized smokers be offered all effective smoking-cessation treatments, including NRT where appropriate.7 Nicotine-replacement therapy is considered appropriate first-line therapy for smoking unless medically contraindicated. Relative contraindications are the presence of severe or unstable angina, serious ventricular arrhythmias, or recent myocardial infarction.7 While patients with these diagnoses are usually hospitalized, many other hospitalized smokers do not have these conditions and would be eligible for NRT. The AHCPR guidelines also endorse the temporary use of NRT during a smoker’s hospitalization with the more limited goal of reducing nicotine-withdrawal symptoms. Despite these recommendations, little is known about the extent or pattern of NRT use in hospitalized smokers. The goal of this study was to describe the prevalence and pattern of NRT use in a large sample of hospitalized smokers.
Section snippets
Methods
We analyzed data from 650 adult smokers who participated in a randomized, controlled trial of an inpatient smoking counseling intervention conducted at Massachusetts General Hospital, an 860-bed Boston teaching hospital that prohibited smoking in all indoor areas at the time of the study. The study methods have been described in detail.8 During 1 year (1994–1995), we recruited adult (≥18 years old) smokers admitted to the medical and surgical services, excluding those who were transferred from
Study population
The study enrolled 650 hospitalized smokers, all of whom survived to discharge. We followed 602 of the 635 survivors (95%) for 1 month and 542 of 615 survivors (88%) for 6 months. The sample was 55% male, 92% white, 42% married, and 42% employed. Mean age was 49.2 ± 16.2 (1 SD) years. Mean educational attainment was 12.4 ± 2.5 years. A prior smoking-related disease diagnosis (ischemic cardiovascular disease, peripheral vascular disease, cerebrovascular disease, chronic obstructive pulmonary
Discussion
Nicotine-replacement therapy was rarely used in this hospital, even among patients who might have particularly benefited from its use, e.g., those who reported having difficulty refraining from smoking in the hospital or who had nicotine-withdrawal symptoms. Even fewer patients used NRT to maintain their tobacco abstinence after hospital discharge despite its established efficacy as a smoking-cessation aid.
The primary indication for NRT is to aid smoking cessation by reducing
Conclusions
In conclusion, this study indicates that NRT is rarely used in the hospital setting, despite the presence of nicotine-withdrawal symptoms among hospitalized smokers. The AHCPR smoking-cessation practice guideline was released in 1996, after this study was conducted (1994–1995), and it is possible that NRT is now more often prescribed to hospitalized smokers. However, the nicotine gum and patch became over-the-counter drugs in 1996. Physicians now prescribe NRT less often to outpatients and may
Acknowledgements
We are indebted to Anne Thorndike, MD, Becky Kemp, Brayden Mathews, and Elizabeth Niewoehner, MD, for help in data collection.
Supported by a grant from the American Cancer Society, Massachusetts Division, and by a National Cancer Institute Preventive Oncology Academic Award (#CA01673) to Dr. Rigotti.
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2011, Public HealthCitation Excerpt :This may be due, in part, to the fact that patients included in the trials analysed did not need NRT as they had low Fagerstrom scores. Indeed, approximately 10 years ago, the use of NRT by smoking inpatients was strikingly low (<10%).21,23 In this study, NRT was used by one-third of smokers; this increase could be related to its free availability, but the reasons for using NRT were the same as before: suggestion of prescription by the physician, high nicotine dependence and serious intention to quit smoking.
Prevalence and correlates of smoking cessation pharmacotherapy in hospitalized smokers with acute myocardial infarction
2011, American Heart JournalCitation Excerpt :Second, patients' use of NRT or other medications for relief of nicotine withdrawal symptoms during hospitalization was unknown. Use of NRT during hospitalization increases the likelihood that patients will receive a prescription for smoking cessation medication at discharge.33 Third, we did not have information about whether the patient was instructed to obtain over-the-counter NRT (instead of receiving a prescription) or whether the patient was offered a prescription for pharmacotherapy and refused treatment.
Treating tobacco dependence: Review of the best and latest treatment options
2007, Journal of Thoracic OncologyCitation Excerpt :According to the USPHS guideline, the patch should be used with caution in patients with recent cardiovascular events (past 2 weeks), cardiac dysrhythmias, or accelerating angina. Data are available suggesting that the nicotine patch is not associated with an increase in cardiovascular events in high-risk outpatients with cardiac disease.7,8 Our clinical experience suggests that NRT is safe even in this population of patients.
Development of a novel prolonged-release nicotine transdermal patch
2005, Pharmacological Research
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