title: Nicotine replacement prescribing trends in a large psychiatric hospital, before and after implementation of a hospital-wide smoking ban.
abstract: OBJECTIVE
  We examined prescribing patterns for nicotine replacement therapies (NRTs) in a large psychiatric hospital, before and after the implementation of a smoking ban.
  
  
  METHODS
  We extracted 5 years of NRT utilization data from hospital pharmacy records. The ban went into effect on January 1, 2007. Data reflect NRT prescriptions from 2 years before and 3 years after the ban, and N = 30,908 total inpatient hospital admissions.
  
  
  RESULTS
  The monthly rate of total NRT prescriptions increased after the ban from M = 254.25 (SD = 126.60) doses per month to M = 4,467.52 (SD = 1,785.87) doses per month (>1,700% increase, p < .0001). After the smoking ban, clinicians prescribed higher doses of transdermal (but not oral) NRT (Tukey, p < .0001). Comparisons of NRT prescribing across hospital units tentatively suggested that patients being treated on the substance use disorders unit were prescribed more doses of NRT, as well as higher doses of NRT compared with patients on other units. Analysis of trends over time showed no apparent downward trend for NRT usage during the 3 years following the smoking ban, suggesting that clinicians continued to treat nicotine dependence after smoking was restricted.
  
  
  CONCLUSIONS
  Clinicians are more likely to identify and treat symptoms of nicotine withdrawal when smoking is restricted. Hospitals should consider monitoring prescriptions for NRT as part of their ongoing quality assurance practices so that patients receive aggressive treatment of nicotine withdrawal symptoms--an essential component of high-quality patient care.
authors.affiliation: Pharmacy and Therapeutics, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA. dscharf@rand.org
authors.forename: Deborah
authors.initials: D
authors.lastname: Scharf
authors.forename: Tanya
authors.initials: T
authors.lastname: Fabian
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fichter-DeSando
authors.forename: Antoine
authors.initials: A
authors.lastname: Douaihy
mesh_terms: D006293:Health Promotion / Q000379:methods; D006778:Hospitals, Psychiatric; D006801:Humans; D009538:Nicotine / Q000008:administration & dosage / Q000627:therapeutic use*; D016134:Organizational Policy; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000639:trends; D012189:Retrospective Studies; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D014029:Tobacco Use Disorder / Q000188:drug therapy*
chemical_list: D009538:Nicotine