Physicians' counseling of patients when prescribing nicotine replacement therapy.
OBJECTIVE
Nicotine patches and gum are now available without a prescription in many countries. Some have expressed concern that allowing access to these medications without a prescription may deprive smokers of the instruction and support they would otherwise have received from their physician. We assessed the value of physician involvement in NRT prescription.


METHODS
We analyzed data interviews from 993 subjects who had filled prescriptions for patch (n=669) or gum (n=324) about physician behavior when prescribing patch and gum when these were available only by prescription.


RESULTS
82% of smokers actually met with the physician; however, only 67% received some instruction in using the medication; only 50% were told about potential side effects; and substantial fractions were prescribed a dose that differed from that recommended on the usage instructions (patch: 24%; gum: 33%). Participants who received no intervention from their physicians were significantly more likely to be abstinent than those participants who received smoking cessation advice and support, likely because physicians offered help to those who most needed it, biasing the association.


CONCLUSIONS
These findings suggest that physicians did not typically perform the helpful behaviors often expected of them or attributed to them.
Shiffman
Saul
S
Pinney Associates, Inc., Pittsburgh, PA 15213, USA. shiffman@pinneyassociates.com
Ferguson
Stuart G
SG
Hellebusch
Stephen J
SJ
D001291:Attitude of Health Personnel; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004366:Nonprescription Drugs; D010353:Patient Education as Topic; D010819:Physician's Role; D010817:Physician-Patient Relations / Q000941:ethics; D011109:Polymethacrylic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D011145:Polyvinyls / Q000008:administration & dosage* / Q000009:adverse effects; D010818:Practice Patterns, Physicians'; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome / Q000523:psychology; D061485:Tobacco Use Cessation Devices
D004366:Nonprescription Drugs; D011109:Polymethacrylic Acids; D011145:Polyvinyls; D009538:Nicotine