Physician counseling of patients when prescribing nicotine replacement therapy

Aims: Nicotine patches and gum are now available without a prescription in many countries. Some have expressed concern that allowing access to these medications without a prescription may deprive smokers of the instruction and support they would otherwise have received from their physician. We assessed the value of physician involvement in NRT prescription.

Design and Participants: We analyzed data interviews from 993 subjects who had filled prescriptions for patch (n = 669) or gum (n = 324) about physician behavior when prescribing patch and gum when these were available only by prescription.

Findings: 82% of smokers actually met with the physician; however, only 67% received some instruction in using the medication; only 50% were told about potential side effects; and substantial fractions were prescribed a dose that differed from that recommended on the usage instructions (patch: 24%; gum: 33%). Participants who received no intervention from their physicians were significantly more likely to be abstinent than those participants who received smoking cessation advice and support, likely because physicians offered help to those who most needed it, biasing the association.

Conclusions: These findings suggest that physicians did not typically perform the helpful behaviors often expected of them or attributed to them.