What happens when GPs proactively prescribe NRT patches in a disadvantaged community.
OBJECTIVE
The high prevalence of smoking in disadvantaged communities gives serious cause for concern in terms of adverse effects on health and social outcomes. In Scotland, smoking -related lung cancer rates are particularly high and compare less favourably with the rest of the U.K. and Europe. GPs are increasingly being recognised as having an important role in smoking cessation and are allowed to prescribe NRT to those on a low income. This study aimed to follow up a group patientsfrom a disadvantaged area who had been prescribed nicotine patches by their GP.


METHODS
An initial self-complete questionnaire gathered details on age, sex, motivation, marital status, employment history, contact with other smokers, concern about weight gain, and nicotine dependence. (Nicotine dependence was assessed by using the Fagerstrom Test). Follow up was carried out at three months after commencing NRT prescription. Data was also gathered from patient case notes as to whether the participant had a smoking-related diagnosis, periods of depression, drug and/or alcohol problems. Outcome was measured in terms of "smoke the same", "smoke less" and "stopped". The statistical methods used for testing each factor against smoking were Spearman rank correlation, chi-squared test for trend and Kruskal-Wallis test. Basic descriptive statistics were used to report general outcomes of the study.


RESULTS
The study enrolled 120 patients but 19 were lost to follow up. Out of 101 who used their prescription, 35 were smoking the same, 46 were smoking less and 20 had stopped. The variables most strongly affecting outcome were age, with older smokers having more success (p < 0.001), and those who had a diagnosis of depression having a worse outcome in terms of smoking cessation (p < 0.05).


CONCLUSIONS
This study's findings indicate that encouraging GPs to take a proactive approach in prescribing NRT is effective, even in an area of socio-economic deprivation, and particularly with older smokers.
Muirhouse Medical Group, I Muirhouse Avenue, Edinburgh. lorrainecopeland@aol.com
L
L
Copeland
R
R
Robertson
R
R
Elton
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D011204:Poverty Areas; D010818:Practice Patterns, Physicians'; D012606:Scotland / Q000453:epidemiology; D012907:Smoking / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D035862:Vulnerable Populations
D009538:Nicotine