TITLE

Do implementation issues influence the effectiveness of medications? The case of nicotine replacement therapy and bupropion in UK Stop Smoking Services

AUTHOR(S)
McEwen, Andy; West, Robert
PUB. DATE
January 2009
SOURCE
BMC Public Health;2009, Vol. 9, p28
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Effective pharmacotherapies are available for smoking cessation but their efficacy is established through randomised controlled trials where the medication is supplied direct to subjects. In health care settings patient access to medicines is often less direct. The process for obtaining supplies of nicotine replacement therapy (NRT) is relatively easy for smokers attending National Health Service (NHS) Stop Smoking Services in the UK, whilst this is not necessarily the case for those wishing to using prescription only medicines (e.g. bupropion and varenicline). This study was a direct comparison of the short-term validated abstinence rates of NRT and bupropion in a clinical setting. Methods: Data were routinely collected from 2626 clients setting a quit date (82% of those registering) with two London NHS Stop Smoking Services that offered behavioural support combined with pharmacotherapy (NRT and bupropion). Results: Contrary to what would be expected from multiple randomised controlled trials, the CO-validated 3-4 week abstinence rate in clients using NRT was higher than for bupropion (42% versus 34%, p = .003). This difference persisted even when controlling for smoking characteristics, demographic variables and treatment variables 1.40 (95% CI = 1.08 - 1.83). Conclusion: Given that the level of behavioural support received by clients on each medication was identical, the most plausible explanation for the difference in effectiveness between NRT and bupropion perhaps lies with how clients of the Stop Smoking Services obtained their medications. Obtaining NRT was relatively easy for clients throughout the study period whilst this was not the case for bupropion. This study suggests that implementation issues and/or self-selection may influence the effectiveness of medications in health care, as opposed to research, settings.
ACCESSION #
51511493

 

Related Articles

  • MEDICATION WEBSITE FOR YOUNG PEOPLE.  // Healthcare Counselling & Psychotherapy Journal;Jul2014, Vol. 14 Issue 3, p44 

    The article reviews the web site, www.headmeds.org.uk, a website launched by YoungMinds on mental health medication for young people aged between 13 and 25.

  • Mentally ill denied nonmedical care.  // Therapy Today;Oct2014, Vol. 25 Issue 8, p4 

    The article reports that according to a survey by Care Quality Commission, fewer than half of people that receive community mental healthcare have been offered non-medical treatment.

  • Where there's smoke…. Elcock, Karen // Nursing Standard;7/11/2007, Vol. 21 Issue 44, p61 

    The article offers information about the smoking policy which bans to smoke within the National Health Services (NHS) property in Great Britain. The policy is applied to nursing students, who smokes to take a plan in coping with their nicotine cravings. Students who crave for cigarette will...

  • A FRESH APPROACH IS NEEDED TO HELP SMOKERS WHO WANT TO QUIT. Rutter, Ailsa // Nursing Standard;12/4/2013, Vol. 28 Issue 14, p34 

    A letter to the editor is presented which is concerned with the role Great Britain's National Health Service could play in smoking cessation.

  • Counselling and recovery. Ellingham, Ivan // Therapy Today;Jul2013, Vol. 24 Issue 6, p30 

    The article offers the author's insights on the recovery from mental distress which is essentially a psychotherapeutic process. The author says that the longitudinal studies by Courtney Harding regarding the people who recovered from severe mental distress have contradicted the Kraepelinian...

  • Choosing Wisely in the UK: reducing the harms of too much medicine. Malhotra, Aseem; Maughan, D.; Ansell, J.; Lehman, R.; Henderson, A.; Gray, M.; Stephenson, T.; Bailey, S. // BMJ: British Medical Journal;5/16/2015, Vol. 350 Issue 8008, ph2308 

    The article focuses on the launch by the Academy of Medical Royal Colleges of a Choosing Wisely programme in Great Britain which aims to change doctors' practice by getting them to stop using various interventions that are not supported by evidence. Topics covered include the release of a report...

  • The depths of depression. Pope, Alan // Therapy Today;Jul2013, Vol. 24 Issue 6, p26 

    The article offers the author's insights on the medicalisation of depression in National Health Service therapy services. The author says that in 2011, the World Health Organization (WHO) considered depression as the fourth leading contributor to the global burden of disease and predicted to be...

  • Opportunity cost of antidepressant prescribing in England: analysis of routine data. Hollinghurst, Sandra; Kessler, David; Peters, Tim J.; Gunnell, David // BMJ: British Medical Journal (International Edition);4/30/2005, Vol. 330 Issue 7498, p999 

    Studies the opportunity cost in the rise of antidepressant prescribing in the NHS by evaluating it in terms of the effective treatment, cognitive behavior therapy. Use of the British Department of Health data to quantify changes between 1991 and 2002; Factors contributing to increased...

  • Research round-up.  // Learning Disability Practice;Jul2014, Vol. 17 Issue 6, p15 

    The article discusses several studies including the one published in the March 2014 issue of the "Journal of Applied Research in Intellectual Disabilities" that examined the association between hearing impairment and learning disability, the other printed in the November 2013 issue of...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics