smokers. Statistically significant differences were observed
between the pre- and post-intervention time periods in terms
of both the percentage of patients who received a prescription
as well as the type of NRT prescription. Educating learners on
the delivery of effective smoking cessation counselling may help
target previously identified barriers.
The purpose of NRT is to replace the nicotine from cigarettes
to both reduce withdrawal symptoms and the motivation to
smoke. The ultimate goal is to assist the patient’s transition
from smoking to abstinence.
Current Canadian best practice
guidelines recommend that all hospitals have a system in place
to identify current smokers and manage nicotine withdrawal
Despite this, the study centre did not
have such a system and these recommendations have been
difficult to sustain when implemented. A multi-faceted approach
is required that includes enabling front-line practitioners, such
as medical residents, to ensure patients have access to NRT
This study adjusted for the number of patients admitted
to the CTU during the pre and post-intervention time period;
however, the relative number of smokers was not captured in the
database. The prevalence of smokers in the general population
of the study area was estimated at 22.4%
which is far above
the number of patients NRT was prescribed for during the
study period. Although possible, it is unlikely that the change
in NRT prescription pre- and post-intervention was due solely
to a change in the prevalence of smokers admitted. A chart audit
undertaken during the study period confirmed that >23% of
patients admitted were active smokers which is expected based
on population data. Future studies should look to find reliable
ways to ascertain the prevalence of active smokers among
admitted patients. Although limited by a small sample size,
this data suggests that integrating formal education on NRT
into the residency curriculum can alter resident prescribing
behaviour in the short-term and is one way to improve the
numbers of hospitalized patients receiving NRT. Sustainability of
our educational session on NRT prescribing was not evaluated,
however this would be helpful to assess in future studies to
determine long-term impact.
Parveen Wasi Resident Research Grant in Medical Education,
McMaster Internal Medicine Program ($3500).
Hamilton Integrated Research Ethics Board (HiREB).
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Canadian Journal of General Internal Medicine
20 Volume 13, Issue 4, 2018
Teaching Residents How to Effectively Prescribe Nicotine Replacement Therapy