(18) Barriers to Prescribing Varenicline and NRT in Inpatient Psychiatric Settings

Background & Introduction: BACKGROUND
Prevalence of smoking is between 53.6% and 91.4% among patients admitted to inpatient psychiatric units1. A psychiatric admission offers an opportunity to implement targeted smoking cessation interventions. Currently there are 3 main pharmacological treatments for nicotine cessation: nicotine replacement therapy (NRT), bupropion and varenicline. Varenicline has been shown to be more effective than NRT and bupropion in achieving abstinence3. Interestingly in a previous study, we had examined a year of prescribing data and discovered no varenicline prescriptions were rendered from our inpatient psychiatric hospital whereas NRT was being routinely prescribed. To further explore the underpinnings of varenicline hesitancy as well as barriers to smoking cessation pharmacotherapy generally we conducted a survey of inpatient psychiatric providers.

Methods: METHODS
An online survey was conducted among healthcare providers at an inpatient psychiatric unit in Cleveland, Ohio. Descriptive statistics were used to analyse the frequency and percentage distribution of responses. The survey comprised of 10 questions, aiming to identify common barriers to the prescription of NRT and varenicline

Results: RESULTS
25 providers completed the survey including resident physicians (76%), attending physicians (20%) and advanced practicing providers (4%). Only 36% of the respondents addressed smoking cessation during hospitalization regularly. Overall limited time was most frequently cited as the primary barrier to addressing smoking cessation. With regards to specific treatments for nicotine cessation, 40% of responders have regularly prescribed NRT while 76% of responders have never prescribed varenicline. While patient refusal was the most frequently cited reason for not prescribing NRT, lack of familiarity with varenicline was the most common reason for not prescribing varenicline. However, 80% of respondents expressed interest in receiving further education on varenicline.

Conclusion & Discussion: CONCLUSION
Our findings that the primary obstacle is the lack of familiarity with varenicline among healthcare providers rather than neuropsychiatric side effects that are well known was unexpected. To address this gap in knowledge it will be crucial to develop comprehensive educational programs and resources that enhance provider knowledge of varenicline and improve strategies for effectively discussing smoking cessation with patients during inpatient admission.
Future QI will be conducted to explore the long-term impact of these interventions.

References: REFERENCES
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2)Sarna L, Fiore M C, Schroeder S A. Tobacco Dependence Treatment is Critical to Excellence in Health Care. JAMA Intern Med. 2020 Nov 1;180(11):1413-1414. doi: 10.1001/jamainternmed.2020.3972. PMID: 32955546

3)Anthenelli RM, Benowitz NL, West R, St Aubin L, McRae T, Lawrence D, Ascher J, Russ C, Krishen A, Evins AE. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet. 2016 Jun 18;387(10037):2507-20. doi: 10.1016/S0140-6736(16)30272-0. Epub 2016 Apr 22. PMID: 27116918

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