Study finds high levels of referrals to tobacco dependency teams but low uptake of Nicotine Replacement Therapy

Background

The smoking prevalence rate in Hull for people over the age of 15 years was 18.4% in 2022, which is higher than the national average for England at 13.8%. Currently, smoking related illnesses cost the National Health Service (NHS) £2.6 billion per year.

Hospital trusts are well placed to identify people who are smokers and to stage an intervention. A lack of documentation or referral to tobacco dependency teams (TDT) means that a key opportunity is being missed to provide nicotine replacement therapy (NRT) and support patients in quit attempts. Long term health benefits include decreased risk of lung cancer, COPD and vascular conditions.

Objectives

To ensure appropriate documentation, referral and prescribing of NRT for inpatient smokers when admitted to hospital. Four standards with a compliance rate of 100% were audited:

1. Documentation of patient smoking status
   2. Referral to TDT offered or made for current smokers
   3. Appropriate NRT offered and prescribed, where the gold standard is a combination of long-acting and fast-acting nicotine replacement therapy
   4. Referred patients seen by the TDT team within 48-hour time frame from admission.

Method

Data was collected retrospectively between 01/11/23 and 15/01/24. The Trusts ePMA team provided a list of 9,669 relevant patients in accordance with the provided data collection table. For data analysis, 300 patients (150 smokers & 150 non-smokers) were selected using a random number generator. The selected sample was descriptively analysed.

Results

The results indicated a good level of documentation of smoking status (99%; 297/300) and most of the patients (95%; 284/300) had information recorded within 48 hours of the admission. All current smokers were offered referral to the TDT.

Although 26% (39/150) of patients accepted NRT, only 18% (27/150) of smokers had some form of NRT prescribed during admission. Of those prescribed NRT, 30% (7/27) patients had both a long- and short-acting NRT prescribed (gold standard).

Conclusions

The audit indicated good engagement with documentation of smoking status and referral of patients to TDT in a timely manner. However, uptake for NRT therapy was low and prescribing of a recommended NRT therapy regime was often not followed.

Further research and education is required to increase the uptake of NRT by hospitalised patients and prescribing of the gold standard therapy. Limitations included retrospective data collection at one hospital, thus limiting insights if the data was true reflection of patient preference with NRT prescribing and how this might have influenced decisions. Follow up studies should involve patient interviews from multiple trusts.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.