An Intervention to Improve Evidence-based Nicotine Prescribing by Primary Care Physicians

Nearly 70% of people who use tobacco want to quit. Combination nicotine replacement therapy (cNRT), a long-acting controller plus short-acting reliever, is the most effective way to prescribe nicotine but is infrequently prescribed by primary care physicians (PCPs). We tested the feasibility and effectiveness of a brief, educational intervention to increase cNRT prescribing by PCPs in a large integrated health system.

We conducted a pre-post study from 2022-2023 at a large integrated health system in California where specific NRT products are covered with a prescription. PCPs were offered a 30-minute virtual training about cNRT during a required monthly meeting (n = 267; 202 attended). The training was interactive, included simple "asks" and a 6-week follow-up communication. Chi-square analysis was used to test for changes in cNRT prescribing behaviors in the 6 months before and after training.

Among physicians who completed a posttraining questionnaire (180/202), 93% reported increased confidence, 91% reported favorable attitudes, and 88% reported intention to prescribe cNRT. According to data obtained from the integrated pharmacy database, the total number of patients who received a cNRT prescription increased from the 6-month pre- to 6-month postintervention from 135 (9%) to 380 (23%), P < 0.001. The total number of physicians who prescribed cNRT increased pre- to posttraining from 78 (23%) to 124 (37%), P < 0.001.

cNRT is an underutilized form of tobacco cessation therapy by PCPs. This may reflect a gap in prescriber knowledge. A brief, virtual training delivered to PCPs was associated with increased cNRT prescribing.