title: Identification of barriers that impede the implementation of nicotine replacement therapy in the acute cardiac care setting.
abstract: BACKGROUND
  Nicotine replacement therapy (NRT) has been shown to increase 12-month abstinence rates by as much as 50% when compared with placebo; however, NRT seems to be underutilized in the acute cardiac setting. This study explores the attitudes and beliefs of healthcare professionals regarding the use of NRT in acute cardiac inpatients, in an effort to identify and expose barriers that may impede the use of this drug in the acute cardiac care environment.
  
  
  METHODS
  Framework analysis formed the methodological foundation of the study and provided the structure for analysis of data generated via qualitative, semistructured one-on-one interviews. A purposive sample of healthcare professionals practicing in the acute cardiac care setting informed the study.
  
  
  RESULTS
  Although health care professionals expressed strong views regarding the benefits of implementing NRT as a smoking cessation intervention, barriers were identified that hinder its use. Financial implications, lack of knowledge and safety issues all contributed to the institutional justification for rejecting hospital-based NRT as a secondary prevention intervention in the acute cardiac setting.
  
  
  CONCLUSIONS
  To proactively reduce the incidence of secondary cardiac events, education of healthcare professionals concerning tobacco addiction and available cessation treatments in the acute cardiac patient is paramount. Nicotine replacement products require further investigation to ascertain their safety and financial viability in the acute cardiac setting. Findings may support the implementation of NRT in the inpatient cardiac setting, and ultimately help curb the incidence of smoking-related mortality owing to secondary cardiac events.
authors.affiliation: Discipline of General Practice, University of Adelaide, North Terrace, Adelaide, South Australia. fiona.may@adelaide.edu.au
authors.forename: Fiona C
authors.initials: FC
authors.lastname: May
authors.forename: Nigel
authors.initials: N
authors.lastname: Stocks
authors.forename: Christopher
authors.initials: C
authors.lastname: Barton
mesh_terms: D000208:Acute Disease; D000328:Adult; D001291:Attitude of Health Personnel; D003325:Coronary Care Units / Q000191:economics / Q000331:legislation & jurisprudence; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004348:Drug Labeling; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000191:economics / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D017721:Hospital Costs; D006801:Humans; D016365:Liability, Legal; D008297:Male; D018722:Nicotinic Agonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D010465:Perception; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D055502:Secondary Prevention; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods*; D000074606:Smoking Prevention
chemical_list: D018722:Nicotinic Agonists