Community pharmacy personnel interventions for …

1 Community pharmacy personnel interventions for smokingcessation (Review)Sinclair HK, Bond CM, Stead LFThis is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published inThe Cochrane Library2008, Issue 4 pharmacy personnel interventions for smoking cessation (Review)Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, A B L E O F C O N T E N T S1 HEADER ..1 ABSTRACT ..2 PLAIN LANGUAGE SUMMARY ..2 BACKGROUND ..3 OBJECTIVES ..3 METHODS ..4 RESULTS ..5 DISCUSSION ..6 AUTHORS CONCLUSIONS ..6 ACKNOWLEDGEMENTS ..6 REFERENCES ..9 CHARACTERISTICS OF STUDIES ..13 DATA AND ANALYSES.

2 Analysis Comparison 1 Intervention versus control, Outcome 1 Cessation at longest follow-up..1313 WHAT S NEW ..13 HISTORY ..14 CONTRIBUTIONS OF AUTHORS ..14 DECLARATIONS OF INTEREST ..14 SOURCES OF SUPPORT ..14 INDEX TERMS ..iCommunity pharmacy personnel interventions for smoking cessation (Review)Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.[Intervention Review] Community pharmacy personnel interventions for smokingcessationHazel K Sinclair1, Christine M Bond1, Lindsay F Stead21 Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, of Primary Health Care,University of Oxford, Oxford, UKContact address: Hazel K Sinclair, Department of General Practice and Primary Care, University of Aberdeen, Foresterhill HealthCentre, Westburn Road, Aberdeen, AB25 2AY, group:Cochrane Tobacco Addiction status and date:Edited (no change to conclusions), published in Issue 4, content assessed as up-to-date:30 October :Sinclair HK, Bond CM, Stead LF.

3 Community pharmacy personnel interventions for smoking Databaseof Systematic Reviews2004, Issue 1. Art. No.: CD003698. DOI: 2008 The Cochrane Collaboration. Published by John Wiley & Sons, B S T R A C TBackgroundSmoking cessation is a potentially appropriate role for Community pharmacists because they are encouraged to advise on the correctuse of nicotine replacement therapy (NRT) products and to provide behavioural support to aid smoking review assessed the effectiveness of interventions by Community pharmacy personnel to assist clients to stop strategyA search was made of the Cochrane Tobacco Addiction Group databasefor smoking cessation studies conducted in the communitypharmacy setting, using the search terms pharmacist* or pharmacy or pharmacies.

4 Date of the most recent search: October criteriaRandomized trials which compared interventions by Community pharmacy personnel to promote smoking cessation amongst theirclients who were smokers compared to usual pharmacy support or any less intensive programme. The main outcome measure wassmoking cessation rates at six months or more after the start of the collection and analysisData were extracted by one author and checked by the second, noting: the country of the trial, details of participant communitypharmacies, method of subject recruitment, smoking behaviourand characteristics of participants on recruitment, method of random-ization, description of the intervention and of any pharmacy personnel training, and the outcome quality was assessed according to the extent towhich the allocation to intervention or control was concealed.

5 Becauseof the potentially important cluster effects, we also rated trials according to whether they checked for or adjusted for these but, in theabsence of consensus on how to pool cluster level data, we adopted a narrative approach to synthesizing the data, rather than pharmacy personnel interventions for smoking cessation (Review)Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, resultsWe identified two trials which met our selection criteria. They included a total of 976 smokers. Both trials were set in the UK andinvolved a training intervention which included the Stages ofChange Model; they then compared a support programme involvingcounselling and record keeping against a control receiving usual pharmacy support.

6 In both studies a high proportion of interventionand control participants began using studies reported smoking cessation outcomes at three time points. However, the follow-up points were not identical (three, sixand 12 months in one, and one, four and nine months in the other), and the trend in abstinence over time was not linear in eitherstudy, so the data could not be combined. One study showed a significant difference in self-reported cessation rates at 12 versus (p < ); the other study showed a positivetrend at each follow-up with versus (p = ) at conclusionsThe limited number of studies to date suggests that trained Community pharmacists, providing a counselling and record keeping supportprogramme for their customers, may have a positive effect on smoking cessation rates.

7 The strength of evidence is limited because onlyone of the trials showed a statistically significant L A I N L A N G U A G E S U M M A R YTrained Community pharmacy personnel may be able to help people who wish to stop smokingPersonnel in Community pharmacies (drug stores) can be a source ofinformation and support for people trying to quit smoking. Theymay have a role because nicotine replacement therapy, an effective cessation pharmacotherapy, is available without prescription in manycountries. People also come to pharmacies with prescriptions for medications to help them quit. The review included two trialsandfound limited evidence that training pharmacy personnel to offer counselling and record keeping services to their customers may helpsmokers to A C K G R O U N DThe Community pharmacist is one of the only health care profes-sionals who has regular interactions with large numbers of people in health as well as in sickness (HEA 1994).

8 This should providean excellent opportunity for pharmacists to contribute to healthpromotion and disease prevention activities in collaboration withother healthcare providers. All of the commercially availableformsof nicotine replacement therapy (NRT) are effective in promot-ing smoking cessation, increasing quit rates to 2-fold regard-less of setting (Silagy 2004). Smoking cessation is a particularlyappropriate role for the Community pharmacist because NRT isavailable without prescription in many countries, although notnecessarily in all of its many formulations (nicotine chewing gum,transdermal patches, nasal spray, inhalators, sublingual tablets andlozenges).

9 Bupropion is also available to patients as a prescriptiononly medicine and therefore largely supplied through the United Kingdom (UK), pharmacists are encouraged to ad-vise on the correct use of NRT products (Royal PharmaceuticalSociety,RPS 1999) and to provide a structured package of be-havioural support to aid smoking cessation (West 2000). However,pharmacists have identified a number of barriers that can inhibitthem from participating in smoking cessation activities, includ-ing dispensing duties (Anderson 2003), lack of counselling skills(Vitale 2000), pharmacist interpersonal characteristics, practicesite considerations, patient characteristics and financial concerns(Williams 2000).

10 Training health professionals in smoking cessation counsellinghas a measurable effect on professional performance, but thereis no strong evidence that it changed clients smoking behaviour(Lancaster 2000;Hudmon 2004). However, an understandingof the trans-theoretical model could improve the effectivenessofcounselling in the pharmacy setting (Vitale 2000;Hudmon 2001).Although smoking cessation training for pharmacy students hasbeen shown to increase perceived confidence and ability to providecounselling (Corelli 2005,Hudmon 2004), the lack of curricu-lum time and lack of experiential training opportunities is still a2 Community pharmacy personnel interventions for smoking cessation (Review)Copyright 2008 The Cochrane Collaboration.