However, abrupt tobacco abstinence precipitated by a hospital admission can provoke nicotine withdrawal symptoms (American Psychiatric Association, 2000). Clinical guidelines selleck bio recommend offering hospitalized smokers nicotine replacement therapy (NRT), which is effective in alleviating these symptoms (Fiore et al., 2008). NRT has been shown in clinical trials to be a safe and effective smoking cessation aid that increases the odds of long-term abstinence by 50%�C70% in outpatients when used for 8�C12 weeks (Stead, Perera, Bullen, Mant, & Lancaster, 2008). However, less than a third of smokers report having used NRT in their last quit attempt (Shiffman, Brockwell, Pillitteri, & Gitchell, 2008). The low rate of NRT use may be partly due to misapprehensions about NRT.
Endorsement of false beliefs about NRT, specifically that it is not safer than smoking, that it is addictive and that it is not effective are common and are associated with not having used the medication in the past and not planning to use it in future quit attempts (Shiffman, Ferguson, Rohay, & Gitchell, 2008). The practice of providing pharmacotherapy to hospitalized smokers may help correct common misunderstandings about NRT. When NRT is offered by hospital staff, patients are assured that the medication is not only safe but also safe for them, given their current health problem. If they accept the offer, they can experience firsthand its ability to reduce withdrawal symptoms and they may receive counseling that will give them greater confidence in the medication and their ability to use it properly.
As a result, those who use NRT in hospital may be encouraged to use NRT at home if they attempt to remain abstinent after discharge. To characterize the use of NRT during and after a hospitalization, we conducted an observational study of smokers who were admitted to a large hospital and routinely referred to its tobacco treatment service (TTS). Patients received counseling and medication recommendations while hospitalized and were followed for 2 weeks after discharge to assess NRT use. Our hypothesis was that the patients who used NRT in hospital would be more likely to initiate use after discharge in an attempt to quit smoking. Methods Setting and Participants This study was reviewed and approved by the Partners Healthcare System Institutional Review Board.
It was conducted at Massachusetts General Carfilzomib Hospital, a 900-bed teaching hospital in Boston, MA. Physicians in the medical, neurology, and surgical services admit inpatients using a computerized order entry system that prompts them to record smoking status and facilitates ordering of NRT at admission. Smokers identified this way are electronically referred to the TTS regardless of their interest in quitting smoking. Patients may also be referred by phone or fax at any time during hospitalization.