title: General practitioner prescribing of single and combination nicotine replacement therapy in the UK: a retrospective database study.
abstract: BACKGROUND
  Guidance in England and Wales recommends that nicotine replacement therapies (NRTs), varenicline or bupropion should be offered for smoking cessation support. Research on general practitioner (GP) NRT prescribing patterns for smoking cessation is lacking in the published literature.
  
  
  METHODS
  UK primary care electronic health records were retrospectively analysed to identify the most common GP initiated NRT prescribing patterns, characterise people who receive NRT and determine whether NRTs given in a first quit attempt are different from subsequent attempts.
  
  
  RESULTS
  The study population comprised 38,954 individuals in UK primary care data with a first ever NRT patch smoking cessation attempt for the period January 2008-December 2011. The majority (64.3%) received NRT patch monotherapy at first smoking cessation attempt, and the most common NRT was 21 mg/24 hours patch monotherapy (15.2%). Of the 35.7% first smoking cessation attempts which were NRT combination therapy, the most common combination was patch + inhalator (56.2%). The proportion of people who started a smoking cessation attempt with combination therapy increased from 25.7% in 2008 to 44.8% in 2011. The majority of the population had one recorded smoking cessation attempt but a significant minority (20.2% N = 7,868) started a second smoking cessation attempt. Second and third attempts, while predominantly patch monotherapy, also demonstrated an increasing use of NRT combinations over the study period (2ndepisode: 20.6%-38.2%; 3rdepisode: 20.0%-36.8%). However, a minority received only non-patch NRT during second and third NRT episodes. Taking into account the 39,068 people prescribed NRT patch during the study period with a history of NRT at baseline (excluded from the analysis), the total proportion of people prescribed NRT patch between 2008-2011 who had more than one NRT episode was 48.4% (46,936/96,986) and of 128,115 NRT users, only 14.7% (N = 18,838) were prescribed bupropion or varenicline prior to NRT use.
  
  
  CONCLUSIONS
  The study findings represent new data describing GP NRT prescription patterns in the UK. Given the predominance of NRT patch monotherapy observed, health policy makers and service commissioners should ensure that GPs provide equality of access to all recommended smoking cessation pharmacotherapies.
authors.forename: Michelle
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Swansea Centre for Health Economics, Swansea University, Wales, UK. p.anderson@swansea.ac.uk.
authors.forename: Pippa
authors.initials: P
authors.lastname: Anderson
authors.forename: Ian
authors.initials: I
authors.lastname: Lockhart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001552:Benzazepines / Q000008:administration & dosage / Q000627:therapeutic use; D016642:Bupropion / Q000008:administration & dosage / Q000627:therapeutic use; D002908:Chronic Disease / Q000453:epidemiology; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011810:Quinoxalines / Q000008:administration & dosage / Q000627:therapeutic use; D012107:Research Design; D012189:Retrospective Studies; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D000068580:Varenicline; D055815:Young Adult
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D016642:Bupropion; D000068580:Varenicline