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Nicotine replacement therapy sampling for smoking cessation within primary care: results from a pragmatic cluster randomized clinical trial
Author(s) -
Carpenter Matthew J.,
Wahlquist Amy E.,
Dahne Jennifer,
Gray Kevin M.,
GarrettMayer Elizabeth,
Cummings K. Michael,
Davis Robert,
Egan Brent M.
Publication year - 2020
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.14953
Subject(s) - nicotine replacement therapy , medicine , smoking cessation , abstinence , odds ratio , confidence interval , context (archaeology) , randomized controlled trial , nicotine patch , cluster sampling , clinical trial , nicotine , physical therapy , emergency medicine , psychiatry , population , alternative medicine , environmental health , placebo , paleontology , biology , pathology
Background and Aims Within the context of busy clinical settings, health‐care providers need practical, evidence‐based options to engage smokers in quitting. Sampling of nicotine replacement therapy [i.e. provision of nicotine replacement therapy (NRT starter kits)] is a brief, pragmatic strategy to address this need. We aimed to compare the effects of NRT sampling plus standard care (SC), relative to SC alone, provided by primary care providers during routine clinic visits. Design Cluster‐randomized clinical trial. Setting Twenty‐two primary care clinics in South Carolina, USA. Participants Adult smokers [ n = 1245; 61% female, mean age = 50.7, standard deviation (SD) = 13.5] both motivated and unmotivated to quit, seen during routine clinical visit. Interventions were provider‐delivered SC ( n = 652, 12 clinics) cessation advice or SC + a 2‐week supply of both nicotine patch and lozenge, with minimal instructions on use ( n = 593; 10 clinics). Measurements The primary outcome was 7‐day point prevalence smoking abstinence at 6‐month follow‐up, using intent‐to‐treat. Additional outcomes included NRT use and quit attempts, assessed at 1, 3 and 6 months following baseline. Findings Seven‐day point prevalence abstinence rates were significantly higher in the NRT sampling group throughout follow‐up, including at 6 months [12 versus 8%, odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.0–2.4]. NRT sampling increased prevalence of any use of NRT (65 versus 25%, OR = 5.8, 95% CI = 4.3–7.7), with higher prevalence of use at 6 months (25 versus 14%, OR = 2.0, 95% CI = 1.5–2.7). NRT sampling increased the rate of quit attempts in the initial month (24 versus 18%, OR = 1.5, 95% CI = 1.0–2.3) but had no significant effect on overall rate of quit attempts (48 versus 45%, OR = 1.2, 95% CI = 0.8–1.7). Conclusion Providing smokers with a free 2‐week starter kit of nicotine replacement therapy increased quit attempts, use of stop smoking medications and smoking abstinence compared with standard care in a primary care setting.