scholarly journals Assessing the delivery of smoking cessation interventions in adult inpatients

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S311-S311
Author(s):  
Katie Blissard Barnes ◽  
Richard Westmoreland
Keyword(s):  
Smoking Cessation ◽  
Physical Health ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Smoking Status ◽  
Service Users ◽  
Nicotine Replacement ◽  
Adult Inpatient ◽  
The Uk ◽  
Brief Advice

AimsTo assess level of compliance with national and local guidance with regards to the recording of service users smoking status and offering of interventions.BackgroundAcross the general population, prevalence of smoking is decreasing but in those with severe mental illness, the prevalence hasn't significantly changed. LYPFT are working towards becoming a smoke-free trust. The Trust Guidance expects that Trusts should ask 100% of service users if they smoke (which should be recorded on their physical health CQUIN) and of those that do, should be offered nicotine replacement therapy and cessation advice. Public Health England is working towards all hospital trusts across the UK being Smoke-free.MethodAll service users on each of the 4 adult inpatient wards at the Becklin Centre, Leeds, were included in the audit. A total of 78 service users were included in the audit.We reviewed the digital records for every service user, specifically looking at the physical health CQUIN. We recorded if smoking status had been documented and what interventions (if any) had been recorded as given. Possible interventions included offering brief advice and offering Nicotine replacement therapy. We then reviewed medication charts to see if any nicotine replacement therapy had been prescribed.ResultThe audit found that approximately half of all service users in our audit smoked cigarettes and that the vast majority of these had their smoking status documented in their digital medical records.Three quarters of those that smoked were offered brief cessation advice and half of them were offered Nicotine Replacement Therapy. Only a third of service users that smoked had NRT prescribed on their medication chart. This represented 65% of those recorded as being offered NRT.ConclusionThere are numerous possible reasons for the above outcomes. These include a lack of knowledge and confidence in delivering smoking cessation interventions, conversations having taken place but not recorded and confusion regarding the appropriate staff member to deliver the intervention. In addition, whilst only medical professionals typically prescribe NRT, the physical health CQUIN is recorded by nurses. Therefore, this may reflect a lack of communication between staff groups.Our trust will become smoke free in the near future. To facilitate this, we hope to reduce the discrepancy between the number of service users who smoke and the number prescribed NRT.

scholarly journals Audit of inpatient smoking cessation advice

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S92-S93
Author(s):  
Flensham Mohamed ◽  
Mohamed Bader
Keyword(s):  
Smoking Cessation ◽  
Risk Factor ◽  
Physical Health ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Smoking Status ◽  
Health Board ◽  
List Type ◽  
Nicotine Replacement ◽  
Smoking Cessation Advice

AimsAudit carried out to assess whether or not patients had been asked about their smoking status during admission onto an acute adult mental health ward, as well as if they had received any smoking cessation advice or offered nicotine replacement therapy.Background•Physical health outcomes in patients with serious mental illness (SMI) are consisitently worse than the general public This is due to multiple factors; adverse effects of medication (including metabolic syndromes with psychotropics) as well as poor lifestyle factors such as smoking status•Patients with an SMI are 3–6 times more likely to die due to coronary artery disease. 70% of patients in inpatient psychiatric units are smokers, a strong independent risk factor for cardiovascular disease.•Smoking cessation is a potent modifiable risk factor that can prevent mortality and reduce morbidity.MethodA cross-sectional review of all 34 inpatients across four general adult acute psychiatric wards.Patient records were explored using the Aneuran Bevan Health Board admission proformas to identify evidence of smoking status and whether advice was offered.ResultSmoker but not given cessation advice n = 13 (38%)Not asked about smoking n = 11 (32%)Smoker and given cessation advice n = 4 (12%)Non-smoker n = 6 (18%)ConclusionPatients were asked about their smoking status the majority of the time (68%) but provision of advice or nicotine replacement therapy was only done in 14% of potential smokers (identified smokers and patients not asked about smoking status).A consideration to be taken into account is that on admission, a patient's physical health status may be unknown, with the additional difficulty of a patient's acute distress complicating the physical examination, smoking status and modification of patient's smoking status may not be the highest priory in that context.Data regarding asking about smoking were different amongst wards, potentially signifying differences between assessors willingness to ask about smoking status.There is a lack of smoking cessation literature available on the wards and patients are often unaware of what options are available to quit smoking.The audit simply determined whether or not assessors were documenting smoking status, it does not measure the quantity or quality of smoking cessation advice provided.Further quality improvement projects should be launched, with focus groups as the intial step at further investigating inpatient smoking rates, as well as attempting to reduce them in a more systemic way.

Effectiveness of nicotine replacement therapy on smoking cessation among pulmonary tuberculosis patients of Mangaluru, India: A randomized controlled trial (Preprint)

2020 ◽  
Author(s):  
Keyword(s):  
Smoking Cessation ◽  
Pulmonary Tuberculosis ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Smoking Status ◽  
Controlled Trial ◽  
Control Group ◽  
Nicotine Replacement ◽  
Tuberculosis Patients ◽  
Brief Advice

UNSTRUCTURED Tuberculosis and tobacco smoking are two largely preventable public health concerns that independently pose a considerable threat to global health. The current estimates put the annual global mortality from the two epidemics at over six million. It is remarkable to note that TB and tobacco use are co-prevalent in many developing nations and these are said to be overburdened by the collision of the two epidemics. This study aims to determine the effectiveness of nicotine replacement therapy on smoking cessation among the pulmonary tuberculosis patients undergoing Directly Observed Therapy- Short Course. This is a randomized, placebo-controlled, two-arm, single blinded trial being conducted in Mangaluru, India. The total sample size including both the arms is 300. This study will be conducted between January 2019 and August 2020. Extra-pulmonary TB, smokeless tobacco users, patients with contraindications for NRT such as recent MI, angina pregnancy & lactation will be excluded from the study.Block Randomization will be done to obtain the two groups using a permuted The experimental group will be given nicotine replacement therapy and brief advice and the control group will be given brief advice and sugar-free chewing gum as a placebo for 3 months on a tapering dosage basis. The smoking status of the patients will be confirmed by urine cotinine test at the baseline and endline. Carbon monoxide monitoring and Fagerstom score will be recorded on a monthly basis.The participants will be followed for another 3 months to obtain a binary variable of smoking cessation status as "Quitter" or Non-quitter". The study also determines the TB outcome between tobacco quitters and non-quitters. Ethical clearance is obtained from the Institutional Ethics Committee of Nitte (deemed to be University) and the trial is registered with Clinical Trials Registry of India.

scholarly journals Practitioners’ Views on Nicotine Replacement Therapy in Pregnancy during Lapse and for Harm Reduction: A Qualitative Study

2019 ◽  
Vol 16 (23) ◽  
pp. 4791
Author(s):  
Ross Thomson ◽  
Lisa McDaid ◽  
Joanne Emery ◽  
Lucy Phillips ◽  
Felix Naughton ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Harm Reduction ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Policy And Practice ◽  
Nicotine Replacement ◽  
Social Ecological ◽  
Pregnant Smokers ◽  
Stop Smoking Services ◽  
The Uk

Many countries, including the UK, recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy. However, adherence to NRT is generally low, smoking lapse or relapse is common and using NRT to reduce the harm from the number of cigarettes smoked is only advocated in non-pregnant smokers. Two focus groups were conducted with 13 professionals involved in antenatal stop smoking services (SSS). The data were analysed thematically. Two themes were extracted that describe health professionals’ attitudes towards using NRT either during lapses or to reduce smoking in women who cannot quit (harm reduction). These are presented around a social–ecological framework describing three hierarchical levels of influence within smoking cessation support: (1) Organizational: providing NRT during lapses could be expensive for SSS though harm reduction could result in services helping a wider range of clients. (2) Interpersonal: participants felt using NRT for harm reduction was not compatible with cessation-orientated messages practitioners conveyed to clients. (3) Individual: practitioners’ advice regarding using NRT during smoking lapses varied; many were generally uncomfortable about concurrent smoking and NRT use and had strong reservations about recommending NRT when smoking during all but the briefest lapses. Further evidence is required to guide policy and practice.

scholarly journals Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis

2021 ◽  
Vol 25 (59) ◽  
pp. 1-224
Author(s):  
Kyla H Thomas ◽  
Michael N Dalili ◽  
José A López-López ◽  
Edna Keeney ◽  
David Phillippo ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Odds Ratio ◽  
Cost Effective ◽  
Credible Interval ◽  
Nicotine Replacement ◽  
The Uk

Background Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes. Objectives To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes. Design Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results. Setting Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes. Participants Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes. Interventions Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies. Main outcome measures Effectiveness – continuous or sustained abstinence. Safety – serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events. Data sources Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019. Review methods Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model. Results Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard. Limitations Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified. Conclusions Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK. Future work Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy. Study registration This study is registered as PROSPERO CRD42016041302. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 59. See the NIHR Journals Library website for further project information.

scholarly journals Smoking Cessation Rate and Its Predictors among Heavy Smokers in a Smoking-Free Hospital in Taiwan

2021 ◽  
Vol 18 (24) ◽  
pp. 12938
Author(s):  
Chin-Jung Lin ◽  
Wei-Hsin Huang ◽  
Che-Yuan Hsu ◽  
Jin-Jin Tjung ◽  
Hsin-Lung Chan
Keyword(s):  
Smoking Cessation ◽  
Heart Disease ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Smoking Status ◽  
Nicotine Replacement ◽  
Cessation Rate ◽  
Important Target ◽  
Logistic Regressions ◽  
Heavy Smokers

Smoking poses critical risks for heart disease and cancers. Heavy smokers, defined as smoking more than 30 pack-year, are the most important target for smoking cessation. This study aimed to obtain the cessation rate and its predictors among heavy smokers. We collected data from heavy smokers who visited a smoking-free hospital in Taiwan during 2017. All patients were prescribed either varenicline or nicotine replacement therapy (NRT) for smoking cessation, and their smoking status was followed for six months. Successful smoking cessation was defined by self-reported no smoking over the preceding seven days (7-day point abstinence). In total, 280 participants with a mean aged of 53.5 years were enrolled, and 42.9% of participants successfully stopped smoking in 6 months. The results revealed that quitters were older, with hypertension, fewer daily cigarettes, and being prescribed with varenicline. Multiple logistic regressions analyses identified that fewer daily cigarettes and being prescribed with varenicline were predictors of successful smoking cessation. Therefore, we suggest that varenicline use may help heavy smokers in smoking cessation.

scholarly journals An audit to assess physical health monitoring of patients following their admission to the general adult psychiatric inpatient wards in Mersey Care NHS Foundation Trust

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S84-S84
Author(s):  
Declan Hyland ◽  
Agatha Milner ◽  
Ellen Carter
Keyword(s):  
General Population ◽  
Physical Health ◽  
Replacement Therapy ◽  
Cholesterol Level ◽  
Nicotine Replacement Therapy ◽  
Health Monitoring ◽  
Hba1c Level ◽  
Serum Cholesterol Level ◽  
Nicotine Replacement ◽  
Adult Inpatient

AimsThis audit aimed to establish whether patients undergo physical health monitoring within 24 hours of admission to one of the general adult inpatient wards in Mersey Care NHS Foundation Trust, as per Trust policy.BackgroundMean life expectancy in individuals with severe and enduring mental illness (SMI) is 15-20 years shorter than that of the general population. A significant proportion of excess mortality in patients with SMI is due to natural causes, e.g. cardiovascular disease and type II diabetes mellitus. Although SMI patients are at greater risk of developing chronic physical health problems, they often receive worse health care than the general population. Shared care of SMI patients between primary and secondary healthcare professionals causes uncertainty over who is responsible for monitoring the physical health of these patients.MethodA list of all inpatients on the eight general adult wards in the Trust was obtained in September 2020, producing a sample of 135 inpatients.An audit tool was designed, capturing demographic data – gender, age, ethnicity. The patient's psychiatric diagnosis was recorded. The tool captured whether each of the following were measured following admission – body mass index (BMI), blood pressure (B.P), serum cholesterol level, QRISK score and HbA1c level, and, if so, whether this was done within 24 hours of admission. For those patients who were smokers, being offered nicotine replacement therapy was documented.ResultOf the 135 inpatients, 10 didn't have any physical health monitoring completed and were excluded from the sample, making the final sample 125 inpatients. 68 of the inpatients were male, 57 were female. 98 had a diagnosis of an SMI, 27 did not. Most inpatients were of “white British” ethnicity. 91% of the sample had a BMI measured within 24 hours of admission, but only 62% had a B.P done, 59% had a serum cholesterol level done and 58% had an HbA1c level done within 24 hours of admission. 78% of eligible patients had a QRISK score calculated. 97% of inpatients who were smokers were offered nicotine replacement therapy, but only 13% accepted it.ConclusionThe majority of patients admitted to the general adult inpatient wards have an SMI. The audit findings show need for improvement in physical health monitoring following admission. Creation and implementation of a checklist of physical health parameters to be measured within 24 hours of admission could help improve performance. Use of motivational interviewing may help increase uptake of nicotine replacement therapy in smokers.

Sign in / Sign up

Export Citation Format

Share Document