An examination of the practice of tailoring smoking cessation pharmacotherapy in a tobacco treatment program within mental health and addictions settings
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Chizimuzo Okoli Assistant Professor, University of Kentucky College of Nursing, Lexington, USA
Abstract
Background and objectives: It is common practice to tailor smoking cessation (SC) pharmacotherapy based on clinical judgement and patient response. This study examines factors associated with such tailoring and its outcomes among smokers with psychiatric and/or substance use disorders who completed an intensive tobacco treatment program within mental health and addictions services settings in Vancouver, Canada.
Methods: A retrospective analysis examined combined program participation data (N=889) from several clinics between September 2007 to March 2013. Seven-day point-prevalence of smoking abstinence (verified by expired carbon monoxide) was assessed at end-of-treatment.
Results: During treatment 60% of participants were maintained on initial pharmacotherapy, 30% received adjunctive treatment, and 10% were switched. Those whose pharmacotherapy was switched had higher cigarette consumption and nicotine dependence at baseline, and were less likely to have a psychiatric disorder history. In multivariate regression analysis, switching pharmacotherapy was associated with lower SC (OR=.33, 95%CI=0.17-.63) and significantly mediated the effectiveness of pharmacotherapy.
Conclusions: The effectiveness of SC pharmacotherapy and SC outcomes can be affected by the tailoring process. The practice of adjunction or switching of SC pharmacotherapy should be further explored through rigorous studies to optimize treatment outcomes among smokers in mental health and addictions services settings.
Source of funding: None
Declaration of interest: Dr Chizimuzo Okoli has received consultation fees from Vancouver Coastal Health Authority and Bluegrass.org in the previous 12 months. These are both community mental health services.
Dr Milan Khara has received unrestricted research funding, speaker’s honoraria, consultation fees or product from the following organisations/companies in the previous 12 months: Interior Health Authority, Pfizer, TEACH, QuitNow Services, Ottawa Heart Institute, Johnson and Johnson, Provincial Health Services Authority, College of Physician’s and Surgeon’s of British Columbia
