Implementation, enrollment, and engagement in an opt-out telehealth pharmacist-assisted tobacco treatment program for patients seen in oncology outpatient clinics.

OBJECTIVE: To describe the workflow, reach, cost, and self-reported quit rates for an opt-out tobacco treatment program (TTP) for patients seen in 43 oncology outpatient clinics. METHODS: Between May 25, 2021, and December 31, 2022, adult patients (≥18 years) visiting clinics affiliated with the Medical University of South Carolina Hollings Cancer Center were screened for smoking status. Those currently smoking were referred to a telehealth pharmacy-assisted TTP. An attempt was made to contact referred patients by phone. Patients reached were offered free smoking cessation counseling and a 2-week starter kit of nicotine replacement medication. A random sample of 420 patients enrolled in the TTP were selected to participate in a telephone survey to assess smoking status 4 to 12 months after enrollment. RESULTS: During the reference period 35,756 patients were screened and 9.3% were identified as currently smoking. Among the 3319 patients referred to the TTP at least once, 2393 (72.1%) were reached by phone, of whom 426 (12.8%) were ineligible for treatment, 458 (13.8%) opted out of treatment, and 1509 (45.5%) received treatment. More than 90% of TTP enrollees smoked daily, with an average of 13.1 cigarettes per day. Follow-up surveys were completed on 167 of 420 patients, of whom 23.4% to 33.5% reported not smoking; if all nonresponders to the survey are counted as smoking, the range of quit rates is 9.3% to 13.3%. CONCLUSION: The findings demonstrate the feasibility of reaching and delivering smoking cessation treatments to patients from a diverse set of geographically dispersed oncology clinics.

Prescription of Nicotine Replacement Therapy for Hospitalized Tobacco Users.

OBJECTIVES: In hospitalized patients, cigarette smoking is linked to increased readmission rates, emergency department visits, and overall mortality. Smoking cessation reduces these risks, but many patients who smoke are unsuccessful in quitting. Nicotine replacement therapy (NRT) is an effective tool that assists patients who smoke with quitting. This study evaluates NRT prescriptions during and after hospitalization at a large health system for patients who smoke. METHODS: A retrospective cohort study was conducted to determine the number of patients who were prescribed NRT during an inpatient admission and at time of discharge from a network of nine hospitals across South Carolina between January 1, 2019 and January 1, 2023. RESULTS: This study included 20,757 patients identified as actively smoking with at least one hospitalization during the study period. Of the cohort, 34.9% were prescribed at least one prescription for NRT during their admission to the hospital. Of the patients identified, 12.6% were prescribed NRT upon discharge from the hospital. CONCLUSIONS: This study identified significantly low rates of NRT prescribed to smokers during hospitalization and at discharge. Although the management of chronic conditions is typically addressed in the outpatient setting, hospitalization may provide an opportunity for patients to initiate health behavior changes. The low rates of prescriptions for NRT present an opportunity to improve tobacco treatment during hospitalization and beyond.

An automated approach to salt selection for new unique trazodone salts.

PURPOSE: The purpose of this study was to establish an automated approach to salt selection and to search for unique trazodone salts for new applications. METHODS: Automated procedures were developed on a Biomek 2000 automation workstation with stacker and plate reader capabilities. Trazodone was dispensed into 96-well plates, and an automated method was set up to form 104 trazodone salts. Salts were observed under a polarized light microscope to determine crystallinity. After stepwise eliminations, the remaining salts were scaled-up and subjected to differential scanning calorimetry (DSC), powder x-ray diffraction (PXRD), hygroscopic, pH-solubility, density, surface area, and particle size analyses. RESULTS: Oils formed in several cases resulting in preliminary elimination of mesyl and esyl salts and four crystallizing solvents. Crystallinity was observed in 34 of 44 scaled-up trazodone salts. PXRD, DSC, and hygroscopic analyses indicated a number of new salts that were comparable in physicochemical parameters to the marketed HCl salt. Among them, the tosylate salt showed uniqueness for new applications. CONCLUSIONS: Automated procedures can be developed to increase the efficiency of pharmaceutical salt selection. The new tosylate salt gave a unique pH-solubility profile with low solubility over the entire pH range making it a potential candidate for a suspension or prolonged action formulation.