The Effectiveness of Nicotine Replacement Therapy - Research Paper Example

 An Audit to Measure the Effectiveness of an NRT (nicotine-replacement therapy) scheme in a Community Pharmacy Introduction Modern researches related to tobacco smoking, quitting and cessation are facing the greatest challenge of which is the most convenient and effective therapy to adopt. Consequently, Nicotine Replacement therapy is at the centre of the discussions with the crucial question being its effectiveness, especially for long-term smoking cessation (Woolacott 2002). Nicotine Replacement Therapy, also known as NRT, strives to prevent the dire craving for tobacco usually exhibited by addicts and as a result, enabling the smoker to abstain from smoking. It is expected that after sometime, the addict or smoker will quit smoking aided by the replacement therapy. The guiding principle towards the cessation and replacement therapy is that direct smoking of tobacco poses many harmful effects to the smoker hence the need to avoid it. This is justified by the number of tobacco related deaths witnessed among active smokers. Through NRT, the victim no longer craves for the smoke making it possible to quit smoking. The most common forms of NRT are nicotine gums and patches, which are administered on the victim by sticking the patches to the harm or providing chewing gums with nicotine (Ferguson et al 2012). Nicotine lozenges, inhalers and sublingual tablets are some of the other forms of NRT. However, the effectiveness of NRT has been questioned based on the cost and degree of success. Research shows that patients who use NRT are more likely to quit smoking (2.5 times) compared to circumstances where NRT is not used. Literature Review Though NRT has been recommended in most Pharmacotherapy, the side effects are central to the cause of key concern areas. More cases of relapsers, temporary lapsers and withdrawal symptoms have been reported among users of the therapy. This makes it difficult to adopt the therapy conclusively since the ultimate goal of complete cessation is unattainable. The appropriateness of NRT is questionable since it points to the direction that most people who are in therapy might constantly depend on nicotine and thus worsen their condition (Bhattacharya, 2004). The victims might be in need of replacement therapy more than they were doing with the smoking. It should also be noted that transdermal nicotine and nicotine gum work on reducing the anticipated withdrawal symptoms while other forms of NRT such as clonidine reduce arousal by smoking. Key findings of such researches explain the significance of each mode. The research finds that, for effective use of transdermal nicotine, there is no need for psychological therapy(Bellenir 2004). Further, it finds that transdermal nicotine and nicotine gum are not consistently effective in managing post cessation weight gain, a critical issue for victims of smoking and cessation therapies. To measure the rate of success of the available therapies, the aspect of nicotine dependence should not be taken to suggest better response in the case of transdermal nicotine. Further, issues raised from previous research are the aspect of effectiveness of NRT with respect to gender. Clonidine, for example, is a more effective form of NRT in women but is not effective for men (Future directions in nicotine replacement therapy 2004). This brings into play, a complex scenario as to which form should be adopted. The success of NRT can be gauged by comparing the proportion of former smokers who quit smoking with aid or without pharmacological help. More than two thirds of those who quit smoking do so without pharmacological help. However, there is increasing need for more professionally mediated forms of cessation due to increasing use of the smoking cessation processes (Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation 2002). This implies that most successful forms of smoking cessation are individually mediated. The available researches do not look into the impact of such individually mediated cessation but instead concentrate on the available interventions. There exists conflict of interest as manufacturers of cessation products fund most cessation studies. The question is raised of their genuine intent in providing the accurate information against the background of their heavy profit targets (McNutt 2007). Most significantly, twice more people quit smoking out of will power as opposed to assisted cessation or use of NRT. This renders the studies and campaigns for the use of NRT as being pharmaceutical industry generated and whose aim is to provide the market for NRT products. Sadly, though, most campaigns by the tobacco control community do not lay the necessary emphasis on self quitters while they form the largest proportions of quitters. Little or no resources have been used or set aside to promote self-quitting while much is used in the case of NRT. It is very suspicious that clinical guidelines choose to ignore unassisted cessation and promote pharmacotherapies thus becoming agents of the pharmaceutical companies (Nicotine replacement therapy (NRT) and bupropion (Zyban) to help quit smoking 2004). The other crucial consideration in the effectiveness of NRT in smoking cessation is the cost of cigarettes compared to NRT. As a matter of economics, more people may become addicted to NRT as a positive trend but fail to maintain it due to the high costs associated with theme compared to per unit of cigarettes. At an average cost of 20 pounds for any NRT for seven days, cigarettes provide a cheap alternative at a cost of 4 pounds for a pack of twenty depending on how much a person can smoke in a week. Therefore, most smokers find it easy to spend gradually and avoid the instant high cost of NRTs. If the methods of prescriptions are adopted where several products can be included in one script, the cost of NRT is reduced and can even become zero thus becoming more effective (Hughes 1993 p743). A study by Silagy et al concludes that the use of NRT increases the odds of smoking cessation by up to 2 times if effectively used. It further finds that the use of NRT is independent of psychological support to the smoker and so can succeed without intense support though the support can speed up quitting process. Research in the past five years provides an indication contrary to the thought that NRT is effective. It provides as a foundation of argument, that although NRT and associated medication have been available for easy access over the counter for over 15 years, cessation rate have stagnated (Brizer 2003). This is according to statistics obtained from U.S CDC. Therefore, more research needs to be conducted to establish the significant contribution of NRT in smoking cessation if it were to be justified to based on the funding proportion it currently receives. Criterion and Standards In the NRT service evaluation, the criteria is that, at least 60% of NRT users should be able to quit smoking after 6 months of using the service. This is the only way to justify the effectiveness of the services compare to other mechanisms (West, Hajek, Stead and Stapleton 2005, p300). However, the standard required for such a trial is that 100% of NRT users should actually quit smoking. Since this is not possible due to cases of relapse and experimental variations, 60% would be good enough to justify the effectiveness of the service (Carr 2004). Study methodology and Design In order toy achieve the aim and objective, the study should be designed in a way that it would be able to compare the results and give clear measurable parameters from where the stated aims and objectives can be analyzed. This study can effectively be achieved by use of the attached questionnaire (Martin and Thompson 2000). As a community pharmacy, the study can manage to recruit a good number of NRT users in the community. This can be done by targeting the people who frequently buy various NRT products and use them either with guidance from medical practioners or unaided. Further, participants who use other mechanisms of smoking cessation should be recruited to provide the basis for comparison (Aldrich 2006). For appropriate sample in this study, 25000 participants who use NRT and 2500 participants who use other mechanisms is necessary. This is enough samples to provide sufficient statistical evidence. The study should not the participant’s willingness to quit smoking and the duration for which they have been smoking. Since it is the use of NRT, which is being investigated, cases of relapse are not of great concern since it is the duration one takes to quit smoking which is necessary. That is, if the individual eventually quits. Having carefully identified and recruited the participants, true records of month when the individual started using the service is noted for the purpose of establish the duration before the person can completely quit smoking (Nicotine replacement therapy 1999). The same is done for the other alternative mechanisms. Since most NRT users acquire their supplies on weekly basis, the records are updated on weekly basis where possible and in some cases, monthly. The participant provides information on frequency of smoking, which will show reduction if possible and will stagnate if the participant is not making any improvement. This means that every participant will have an individual study form and progress record over the period of the study (Katz 2010). The records for those who use other mechanisms of cessation schemes is also done in the same fashion to ensure the two can be compared. For patients who fail to turn up after two weeks before the study period ends, follow-ups and checks should be done. This will help establish whether the individual is still in the program, has quit smoking or has had a relapse (Perkins, Conklin and Levine 2008). Results and Analysis After the study period of six months, it will be possible to sort the data in terms of the number of participants who successfully quit smoking by the use of NRT, the numbers who had a relapse and the numbers who after six months were still unable to quit (Malcolm 1996). An extended study can then be done on the participants who did not quit but were still progressing. This will help in determining the maximum time it can take to quit smoking aided by NRT. With the analysis of data on other mechanisms, the degree of success or effectiveness of NRT will be established. If NRT proves to be effective in the region of 60% as in the criteria, then it is actually effective method of smoking cessation. Further, the method can be compared to other modes and determine as to which one is more effective and which patients can keep p with over a long period. Study Tool The study tool effective and which is designed for this study is the questionnaire. This is a survey form which is detailed to capture all the required details of withdrawal and quitting for each patient of the study period (Woolacott 2002). The survey forms should be administered in accordance with the guidelines of acceptable and ethical research to avoid conflicts. Tobacco smoking and cessation is a controversial issue and so addressing it requires compliance with medical and societal norms to avoid unbiased data due to stigma associated with it. Appendix I: Study Tool Patient identifier: Sex: M / F Age: Survey No.: Date:..../.../...... Week:........ Crite-rion No. Data Item No. Criterion Yes No NA/ Exceptions Details A) People planning to stop smoking 1 1.1 1.2 1.3 For those people who want to stop smoking: Is the decision to quit smoking recommended by a Medic? Is the decision to stop smoking personal? Have you been smoking for long? (Data source: Patient)       ……………… ……………… ……………… ..Years...months 2 2.1 2.2 2.3 Are you aware of the available cessation schemes? If yes: How many cessation schemes is the participant aware of. Which are the types of cessation schemes the participant is aware of (Data source: patient records)   ……………… ……………… ……………… ......(numbers) ........(list) 3 3.1 3.1.1 3.1.2 Are you planning to stop smoking? If yes, which method are you using? - NRT - Other(specify) (Data source: patient response)       ……………… A / B / ........,(specify) B) People Using NRT 4 4.1 4.2 4.3 Smoker’s date of starting using NRT: Smoker’s target stop date: Is there observed progress towards quiting? If yes, what is the reduction in packets of cigarette smoked per week? (Data source: patient review) …../…./…. …../…./….   ……………… ……………… ……………… .......(pkts/sticks) C) People Using other Methods 5 5.1 5.2 5.3 5.4 Smoker’s date of starting using NRT: Smoker’s target stop date: Is there observed progress towards quiting? If yes, what is the reduction in packets of cigarette smoked per week? (Data source: patient records) …../…./…. …../…./….   ……………… ……………… ……………… .......(pkts/sticks) References Aldrich, M, (2006) Stop smoking. Chicago, IL: Contemporary Books. Bellenir, K, (2004) Smoking concerns sourcebook: basic consumer health information about nicotine addiction and smoking cessation .... Detroit, MI: Omnigraphics. Brizer, D, A, (2003) Quitting smoking for dummies. Hoboken, NJ: Wiley. Carr, A, (2004) The easy way to stop smoking ([Rev. and updated]. ed.). New York: Sterling Pub. Co.. Chapman S, MacKenzie R (2010) The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences. PLoS Med 7(2): e1000216. doi:10.1371/journal.pmed.1000216 Ferguson J, Docherty G, Bauld L, Lewis S, Lorgelly P, Boyd KA et al. (2012) Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: randomised controlled trial. BMJ; 344:e1696. Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation. (2002). London: NICE. Hughes, John R. (1993) Journal of Consulting and Clinical Psychology, Vol 61(5), Oct 1993, 751-760. Special Section: Clinical Research in Smoking Cessation. Katz, M H, (2010) Evaluating clinical and public health interventions: a practical guide to study design and statistics. Cambridge: New York :. Malcolm, M, (1996) Nicotine replacement therapy & smoking cessation programmes: consultant report to Central RHA. Wellington, N.Z.: Murray Malcolm. Martin, C. R., & Thompson, D. R. (2000). Design and analysis of clinical nursing research studies. London: Routledge. McNutt R, (2007) Nicotine replacement therapy and brief motivational interview for emergency department smokers with asthma. New Haven, Conn.: s.n.]. Nicotine replacement therapy (NRT) and bupropion (Zyban) to help quit smoking. (2002). Glasgow: The Board. Nicotine replacement therapy and bupropion: their place in smoke-free hospital policies.. (2003). Croydon: International Network Towards Smoke-Free Hospitals. Nicotine replacement therapy: information for health care professionals. (1999). East Perth, W.A.: Health Promotion Services, Health Dept. of Western Australia. Nicotine replacement therapy: the evidence (1996) Sydney, N.S.W.: Nicotine Replacement Therapy Assoc. Inc.. O'Connell, Kathleen, A, Martin, Edwin, J, (1987) Journal of Consulting and Clinical Psychology, Vol 55(3), Jun 1987, 367-37 Perkins, K, A, Conklin, C, A, & Levine, M, D, (2008) Cognitive-behavioral therapy for smoking cessation: a practical guidebook to the most effective treatments. New York: Routledge. West, R, Hajek, P Stead, L & Stapleton, J, (2005) Outcome criteria in smoking cessation trials: proposal for a common standard, Vol 100 (3), March 2005, 299-303 Woolacott, N, F, (2002) The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation. Southampton: National Coordinating Centre for Health Technology Assessment, University of Southampton. Read More