Trends in Prescribing of Nicotine Replacement Therapy to Pregnant Women in Primary Care in England

Abstract

Introduction Smoking during pregnancy remains common and the English National Health Service (NHS) has recently been directed to prioritise providing cessation support for pregnant women. We investigated the impact on prescribing of stop smoking treatments to pregnant women of the 2013 transfer of public health budgets from the NHS to administrative authorities responsible for local social care and other non-health services (local authorities). Methods We used data from the Clinical Practice Research Datalink and Hospital Episode Statistics to determine annual proportions (2005-2017) of women who smoked during pregnancy and who were prescribed, at least once before childbirth, a) any NRT and b) long- and short-acting NRT together (dual NRT). Segmented regression was used to quantify the impact of the 2013 transfer of smoking cessation budgets to local authorities, assessing changes in the level and the trend of the proportions post-2013 compared to pre-2013. Results We identified 84,539 pregnancies in which women were recorded as smoking; any NRT was prescribed in 7.9% (n=6,704) and dual NRT in 1.7% (n=1,466). Prescribing of any NRT was declining prior to 2013 at an absolute decrease of -0.25% per year, but the rate of decline significantly increased from 2013 onwards to -1.37% per year. Prescribing of dual NRT was increasing prior to 2013 but also decreased post-2013. Conclusions These findings suggest that transferring responsibility for English Smoking Cessation Services from the NHS to local authorities adversely affected provision of cessation support in pregnancy. Consequently, some women may have been denied access to effective cessation treatments. Implications Women who smoke during pregnancy may be being denied potentially effective means to help them quit, contrary to NICE guidance, at what can be a teachable moment with substantial immediate and longer-term health benefits for woman and their unborn child, and economic benefits for the NHS. When the organisations responsible for offering smoking cessation support are changed, health systems should consider potential adverse effects on the delivery of support and deploy strategies for mitigating these.

Protocol for iSISTAQUIT: Implementation phase of the supporting indigenous smokers to assist quitting project

“…Despite 95% believing that NRT is safer than smoking, only 5–21% prescribe NRT and only 5–14% follow-up women [ 19 ]. These rates are similar to studies conducted internationally [ 20 , 21 ].…”

Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies

“…Categorisation of 'cessation interventions': 'None' or 'Advice once' or 'Advice several times' or 'Nicotine patch/gum' or 'Other' Domain 9. Change infrastructure Szatkowski, 2021 [ 36 ] England 66. Mandate change Repeated cross-sectional study Segmented regression analysis, no control Pregnant women, aged 15–49 years at time of giving birth, smokers during pregnancy 2005 to 2017: n = 84,539 pregnancies where the mother was recorded as smoking, this was 24.9% of n = 339,875 all pregnancies Data source: UK-representative primary care electronic healthcare records, CPRD Outcome measure: "Women were identified as smoking in pregnancy if they had a diagnostic code indicating current smoking, or a prescription for a smoking cessation medication, recorded at least once during gestation."…”

Smoking Cessation Support for Pregnant Women Provided by English Stop Smoking Services and National Health Service Trusts: A Survey

“…These guidelines recommended the use of psychosocial interventions and nicotine replacement therapy (NRT), which provides nicotine in a form that does not include the harmful elements found in tobacco smoke [11]. In 2013, the responsibility for public health and the commissioning of stop smoking services (SSSs) in England transferred from the National Health Service (NHS) to local government, and this has been accompanied by a decrease in NRT prescribing to pregnant women by General Practitioners [12]. In 2018, most local authorities (LA) commissioned a specialist SSS in which stop smoking advisers offer evidence-based behavioural support alongside pharmacotherapies to help people stop smoking as part of a programme of one-to-one or group support [13].…”