Abstract
BackgroundLarge-scale distribution efforts of free nicotine replacement therapy (NRT) have been documented to be cost-effective interventions for increasing smoking quit rates. However, despite nearly a dozen studies evaluating their effectiveness, none have examined whether free NRT provision promotes further primary care help-seeking and the impact that it may have on cessation efforts.MethodsIn the context of a randomized controlled trial, a secondary analysis was conducted on 1000 adult regular smokers randomized to be mailed a 5-week supply of nicotine patches or to a no intervention control group. Recipients and users of free nicotine patches at an 8 week follow-up were successfully case matched to controls based on age, gender, baseline level of nicotine dependence and intent to quit (n = 201 per group). Differences in physician interaction between the two groups were evaluated at both 8 week and 6 month follow-ups. The impact of physician interaction on self-reported smoking abstinence at each follow-up was also examined.ResultsAlthough no differences in physician interaction were noted between groups at the 8 week follow-up, at the 6 month follow-up, nicotine patch users reported greater frequency of discussing smoking with their physician (43.9%), as compared to the control group (30.3%) (p = 0.011). Across both groups, over 90% of those that discussed smoking with a physician were encouraged to quit and approximately 70% were provided with additional support. Separate ANOVAs revealed no significant impact of physician interaction on cessation (p > 0.05), regardless of group or follow-up period, however, at the 6 month follow-up, nicotine patch users who discussed cessation with a physician had made serious quit attempts at significantly greater rates (72.6%), compared to controls (49.1%) (p = 0.007).ConclusionsIrrespective of group, the majority of smokers in the present study did not discuss cessation with their physician. Recipients and users of nicotine patches however, were more likely to discuss smoking with their physician, suggesting that the provision of free NRT particularly to those who are likely to use it may facilitate opportunities for benefits beyond the direct pharmacological effects of the medication.Trial registrationclinicaltrials.gov, NCT01429129. Registered: 2 September 2011.
Highlights
Large-scale distribution efforts of free nicotine replacement therapy (NRT) have been documented to be cost-effective interventions for increasing smoking quit rates
The trial revealed that the provision of cost-free nicotine replacement therapy (NRT) or bupropion in combination with general practitioner training strongly increases the odds of cessation and is markedly cost-effective in reducing smoking-related morbidity [14, 15]. As these findings suggest that smoking cessation support and provision of free pharmacotherapy in primary practice is an effective strategy of reducing smoking prevalence in the general population, cost-free medication provision appears to be an important component of achieving higher abstinence rates
In the context of a randomized controlled trial evaluating the efficacy of mass distribution of free NRT to smokers, the aim of this study was to examine whether and to what extent the provision of free NRT impacts smokers’ interaction with primary care physicians
Summary
Large-scale distribution efforts of free nicotine replacement therapy (NRT) have been documented to be cost-effective interventions for increasing smoking quit rates. The Clinical Practice Guidelines for Treating Tobacco Use and Dependence, originally developed in 1996 by the United States Department of Human Health Services, stress that primary care physicians should treat tobacco dependence as a chronic disease and follow the 5A’s model of: asking about smoking, assessing readiness to quit, advising smokers to stop, assisting patients with treatment, and arranging follow-up. These forms of intervention have been shown to be quite effective in motivating and driving smokers to quit, where even brief advice increases the odds of cessation [3, 4]. Combined behavioral counseling and pharmacotherapy has been shown to be the most effective at treating tobacco dependence, producing the highest odds of quitting and progressively higher quitting estimates with increased number of counseling sessions [5]
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