Drugs to support smoking cessation in UK general practice: are evidence based guidelines being followed?
BACKGROUND
Prescribing drugs to support smoking cessation is one of the most cost effective interventions in primary care, but there is evidence they are underused. Little is known about how far guidelines have been adopted.


OBJECTIVE
To examine the context in which nicotine replacement therapy (NRT) and bupropion are prescribed in UK general practice and whether guidelines are being followed.


METHODS
Patient questionnaire survey.


METHODS
Twenty five general practices from the Trent Focus Collaborative Research Network in South Yorkshire and East Midlands, UK.


METHODS
Participating practices posted a questionnaire to up to 40 patients prescribed NRT and bupropion respectively in the previous 3-9 months.


RESULTS
The response rate for people prescribed NRT was 44.7% (323/723) and for bupropion 42.5% (77/181). Patients reported initiating the prescription request in 258 cases (65%), whereas GPs were reported as suggesting it in 49 (12%), smoking cessation services (SCS) in 38 (10%), and practice nurses in 36 (9%). Of those who could recall the content of the consultation in which NRT or bupropion was prescribed, 191 (79%) reported receiving advice on treatment use and 209 (68%) were encouraged to set a quit date. Follow up by SCS was recommended to 186 (64%) and practice follow up was offered to 212 (63%), but 41 (15%) reported no offer of follow up support.


CONCLUSIONS
The majority of patients reported receiving advice and follow up in line with guidelines. However, relatively few prescriptions were suggested by GPs or practice nurses and, in a significant minority of cases, neither follow up by the practice nor additional support from SCS was recommended. More active implementation of guidelines could increase the impact of general practice on the prevalence of smoking.
Wilson
A
A
Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK. aw7@le.ac.uk
Sinfield
P
P
Rodgers
S
S
Hammersley
V
V
Coleman
T
T
D000328:Adult; D016642:Bupropion / Q000627:therapeutic use*; D003376:Counseling; D017723:Drug Utilization Review; D004739:England; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires
D018722:Nicotinic Agonists; D016642:Bupropion