The use of nicotine-replacement therapy by hospitalized smokers

Background: No-smoking policies are mandatory in U.S. hospitals. Consequent ly, smokers who are hospitalized must temporarily stop smoking. Nicotine-re placement therapy (NRT) could help hospitalized smokers relieve nicotine wi thdrawal symptoms, comply with no-smoking policies, and sustain tobacco abs tinence after discharge. The extent of NRT use in the hospital setting is u nknown. We describe the prevalence and patterns of NRT use in hospitalized smokers. Design: Prospective observational study within a randomized smoking-interve ntion trial. Setting/Participants: Six hundred fifty adult smokers admitted to the medic al and surgical services of a large urban teaching hospital that prohibits smoking in all indoor areas. Follow-up was at 6 months. Main Outcome Measure: Inpatient pharmacy records of nicotine patch or gum u se. Results: Only 34 of 650 smokers (5.2%) received NRT during their hospital s tay, including only 9.6% of smokers who reported difficulty refraining from smoking while hospitalized and 9.0% of hospitalized smokers with nicotine withdrawal. NRT was more likely to be prescribed to patients with nicotine withdrawal (OR 2.23; 95% CI: 1.01, 4.90), a higher daily cigarette consumpt ion (OR 1.04; 95% CI: 1.01, 1.06), and a longer hospitalization (OR 1.05; 9 5% CI: 1.00, 1.10). NRT use was independent of a patient's intention to qui t smoking after discharge and was not associated with smoking cessation 1 a nd 6 months after discharge. Conclusions: NRT was rarely used in this hospital, even among those who cou ld have benefited from it to treat nicotine-withdrawal symptoms. When NRT w as used, relief of nicotine withdrawal, rather than assistance with smoking cessation, appeared to be the primary goal. Greater use of NRT could benef it the estimated 6.5 million smokers who are hospitalized annually by reduc ing nicotine withdrawal, encouraging smoking cessation, and ensuring compli ance with hospital no-smoking policies.