Poor Initiation Of Smoking Cessation Therapies In Hospitalised Patients With Chronic Obstructive Pulmonary Disease Is Associated With Low Levels Of Formal Training Among Hospital Doctors And Under-Utilisation Of Nursing-Led Interventions

Background: Smoking cessation intervention is a key component in the management of chronic obstructive pulmonary disease (COPD).Aims: To evaluate the prescribing of smoking cessation therapies (SCT) among hospital clinicians and identify factors that may hinder delivery of effective interventions.Methods: A retrospective analysis of medical records of patients admitted to the Royal Hobart Hospital with an acute exacerbation of COPD was performed. A survey of hospital clinicians was also performed to ascertain levels of training and confidence in prescribing SCT.Results: Nearly all medical and non-medical hospital clinicians self-reported confidence in offering SCT (91.1 vs 82.5%, respectively, P = 0.216). However, of the 122 eligible patients in our study population, the majority did not have any form of SCT initiated during their admission (n = 68, 55.7%) and only 21 patients (17.2%) were referred to the nurse-led smoking cessation service. Very few patients were initiated on efficacious regimes such as combination-nicotine replacement therapy (n = 8, 6.6%) or varenicline (n = 2, 1.6%). Only a small proportion of hospital doctors reported confidence in prescribing varenicline and bupropion (17.2 and 6.9%, respectively). Furthermore, very few hospital doctors reported ever receiving formal training in SCT compared to non-medical hospital staff (42.2 vs 84.5%, P < 0.001).Conclusion: Our study highlights the real-life challenges in tackling nicotine dependence in hospitals: under-utilisation of evidence-based pharmacotherapies, limited access to formal training for doctors and poor uptake of nurse-led smoking cessation services. Granting limited prescribing rights for specialised nurses may help hospital clinicians to alleviate gaps in current clinical practice.