Category: Federal Forum Posters
Purpose: Tobacco use is the #1 cause of preventable death and disease in the U.S. It is also a chronic relapsing condition that often requires repeated interventions. At VA Long Beach Healthcare System, recent changes in the care system allow both pharmacists and non-pharmacist (e.g. physicians, nurse practitioners, physician assistants) to be tobacco cessation providers and in the different care settings. This study aims to describe the similarities and differences in patients who received tobacco cessation products (e.g. Nicotine replacement products of different forms, bupropion for tobacco cessation and varenicline) prescribed by the pharmacists and the non-pharmacist providers.
Methods: This is an Institutional Review Board approved, retrospective database review study. The study period was from October 1, 2018 to April 30, 2019. All patients who were issued an outpatient prescription on any of the tobacco cessation product listed above were included. Collected data were demographic characteristics (age, gender, race, ethnicity), body mass index at baseline and 6 months after first prescription issue date, history of tobacco cessation product(s) used, evidence of comorbidities (e.g. cardiovascular diseases, stroke, lung diseases, cancer, diabetes, hypertension, hyperlipidemia and mental health) within a year from first prescription issue date, hospitalization and mortality during the study period. Descriptive statistics, chi-squared, and t tests were utilized to compare between pharmacist prescribers vs. non-pharmacist prescribers. Logistic regression was conducted to identify potential factors that were different in the pharmacist vs. non-pharmacist prescribers’ cohorts.
Results: Of the total of 768 patients issued tobacco cessation products during the study period, 458 (59.8%) patients received them from pharmacist providers. In comparing between the study cohorts, the average age (years) was 56.4 and 53.1. The majority of patient were white 55.2% vs. 57.4%, with 11.3% and 17.1% were Hispanic, respectively. For both groups, the most prescribed product was nicotine patches, with nicotine patch 7mg dose is of highest percentage (81.0% vs. 73.9%, respectively). Pharmacist prescribers statistically significantly prescribed more nicotine gum and lozenges and varenicline than non-pharmacist prescribers, Odd Ratio (OR): 2.47; 95% Confidence Interval (CI) [1.68 – 3.61]; OR: 1.48, 95% CI [1.11 – 1.99]; and OR 9.54, 95% CI [1.44 – 63.29], while prescribing less bupropion OR: 0.64, 95% CI [0.40 – 1.00], respectively. Logistic regression controlled for demographic characteristics (age, sex, race and ethnicity) and other collected variables (comorbidities, history of tobacco cessation products used, body mass index) suggested that there were no differences between the cohort of the patients seen and prescriptions issue by pharmacists compared to non-pharmacist prescribers (Chi-square = 0.27; R-square = 0.196).
Conclusion: It is appeared that all prescribers preferred nicotine patches as the mainstay of tobacco cessation therapy. There were some differences in prescribing patterns between pharmacists and non-pharmacist provider with pharmacist prescribers issued more gums, lozenges and varenicline and less bupropion prescriptions than the non-pharmacist prescribers