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Thai T, Lancsar E, Spinks J, Freeman C, Chen G. Understanding Australian pharmacy degree holders' job preferences through the lens of motivation-hygiene theory. Soc Sci Med 2024; 348:116832. [PMID: 38569288 DOI: 10.1016/j.socscimed.2024.116832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
Increasing the contribution of pharmacists to primary care has been long discussed, particularly in the context of health workforce shortages and the push to better integrate all providers across primary care. This study examines the employment preferences of Australian pharmacy degree holders (PDHs) elicited through a discrete choice experiment (DCE), to better understand the drivers of current labour force choices. A labelled DCE was developed incorporating the six employment sectors: hospital pharmacy, community pharmacy, primary healthcare settings, pharmaceutical industry, government/academia, and non-pharmacy-related sector. Each alternative was described by five attributes using Herzberg's Two Factor Theory as a conceptual framework. They include motivators - role and career opportunities, and hygiene factors-flexible work schedule, geographic location, and salary. Unforced choice data were analysed using conditional logit and mixed logit models. Based on a sample of 678 PDHs in Australia, our findings indicated pharmaceutical industry is the least preferred sector, followed by non-pharmacy-related sector. Motivators in the form of role and career opportunities are the most important attributes in hospital pharmacy while hygiene factors - geographic location and salary significantly drive the choice of community pharmacy and primary care settings. We provided evidence of a willingness to adopt expanded roles in community pharmacy. This unique interpretation of the key drivers of employment preference in light of motivators and hygiene factors provides policy makers with important information when designing policies to attract and retain PDHs across employment sectors.
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Affiliation(s)
- Thao Thai
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Emily Lancsar
- Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, 63A Eggleston Road, Acton ACT, 2601, Australia
| | - Jean Spinks
- Centre for the Business and Economics of Health, Lev 5, Bld 14, The University of Queensland, St Lucia Campus, Brisbane, QLD, 4072, Australia
| | - Christopher Freeman
- The University of Queensland, School of Pharmacy, Brisbane, QLD, Australia; The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia; Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Level 5, Building H, Caulfield Campus, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia
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Brookfield S, Steadman KJ, Nissen L, Gartner CE. Pharmacist-only supply of nicotine vaping products: proposing an alternative regulatory model for Australia. Tob Control 2024:tc-2023-058414. [PMID: 38599788 DOI: 10.1136/tc-2023-058414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Regulation of nicotine vaping products (NVPs) is an ongoing challenge across the world. Australia currently has a globally unique NVP regulatory model that requires a medical prescription to purchase and use NVPs, with further restrictions in progress in response to evidence of widespread illicit NVP sales. Against this background, we examine the new measures and consider a modification of the model to pharmacist-only supply as an option for increasing access to NVPs for smoking cessation, while retaining health practitioner oversight of supply. We describe the strengths and challenges of implementing a pharmacist-only NVP supply option in Australia. Compared with the current prescription-only model, pharmacist-only supply could increase access to a lower exposure nicotine product in a highly regulated therapeutic context while addressing youth access and purchasing for non-therapeutic use, reduce demand for illicit products for smoking cessation purposes and avoid overburdening medical services with consultations to obtain NVP prescriptions. This approach can also accommodate current government goals such as eliminating NVP advertising, youth-focused branding and supply from grocery and convenience stores.
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Affiliation(s)
- Samuel Brookfield
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland, Herston, Queensland, Australia
| | - Kathryn J Steadman
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland, Herston, Queensland, Australia
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Lisa Nissen
- Centre for the Business and Economics of Health, Faculty of Business Economics and Law, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Coral E Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland, Herston, Queensland, Australia
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Ellis Hilts K, Elkhadragy N, Corelli RL, Hata M, Tong EK, Vitale FM, Hudmon KS. Closing the Tobacco Treatment Gap: A Qualitative Study of Tobacco Cessation Service Implementation in Community Pharmacies. PHARMACY 2024; 12:59. [PMID: 38668085 PMCID: PMC11055024 DOI: 10.3390/pharmacy12020059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/29/2024] Open
Abstract
Tobacco use remains a leading preventable cause of morbidity and mortality, with pharmacotherapy and counseling recognized as effective cessation aids. Yet, the potential role of pharmacists and pharmacy technicians in tobacco cessation services is underutilized. This study explores the integration of such services in community pharmacies, identifying facilitators and barriers to their implementation. A qualitative study was conducted across seven community pharmacies in California that were affiliated with the Community Pharmacy Enhanced Services Network. Participants included 22 pharmacists and 26 pharmacy technicians/clerks who completed tobacco cessation training. Data were collected through semi-structured interviews, focusing on experiences with implementing cessation services. The analysis was guided by Rogers' Diffusion of Innovations Theory. MAXQDA software was used for data management and thematic analysis. Sixteen pharmacy personnel participated in the study, highlighting key themes around the integration of cessation services. Compatibility with existing workflows, the importance of staff buy-in, and the crucial role of pharmacy technicians emerged as significant facilitators. Challenges included the complexity of billing for services, software limitations for documenting tobacco use and cessation interventions, and gaps in training for handling complex patient cases. Despite these barriers, pharmacies successfully initiated cessation services, with variations in service delivery and follow-up practices. Community pharmacies represent viable settings for delivering tobacco cessation services, with pharmacists and technicians playing pivotal roles. However, systemic changes are needed to address challenges related to billing, documentation, and training. Enhancing the integration of cessation services in community pharmacies could significantly impact public health by increasing access to effective cessation support.
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Affiliation(s)
- Katy Ellis Hilts
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA;
| | | | - Robin L. Corelli
- School of Pharmacy, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Micah Hata
- College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA;
| | - Elisa K. Tong
- Department of Internal Medicine, UC Davis, Sacramento, CA 95817, USA;
| | - Francis M. Vitale
- College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA;
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Dineen-Griffin S, Benrimoj SI. The landscape of self-care in Australia: A pharmacy perspective. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100396. [PMID: 38174289 PMCID: PMC10762451 DOI: 10.1016/j.rcsop.2023.100396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
The evolving landscape of self-care in Australia underscores the imperative of recognizing and integrating the crucial role of pharmacists in promoting greater levels of self-care. Although the social and economic justifications for self-care are acknowledged internationally and in the literature, there is very little policy recognition in relation to self-care specifically in Australian health policy. Additionally, the distinct contributions of pharmacies to self-care, i.e., their experiences and accessibility in primary health care, are not consistently highlighted. Community pharmacies in Australia are currently navigating a transformative shift, expanding their scope of practice to deliver highly individualized care, with a special emphasis on the implementation of professional services crucial for the sector's enduring viability. Although pharmacists already play a substantial role in supporting self-care, there exists a compelling demand for a systematic and structured approach. Despite the limited availability of theoretical frameworks or models for pharmacists in self-care support within the existing literature, tangible practical evidence attests to the success of interventions. In an era where patients increasingly assume responsibility for self-managing conditions, the pharmacist's role in facilitating self-care and judicious self-medication is pivotal, promising not only tangible benefits for individuals but also contributing significantly to the long-term sustainability of the healthcare system in Australia. This necessitates a strategic and comprehensive framework that positions pharmacists as essential catalysts in the broader landscape of healthcare, ensuring their contributions are optimally leveraged to enhance patient outcomes and system efficiency.
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Affiliation(s)
- Sarah Dineen-Griffin
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, New South Wales, Australia
| | - Shalom I. Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Spain
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Hoek J, Muthumala C, Fenton E, Gartner CE, Petrović-van der Deen FS. New Zealand community pharmacists' perspectives on supplying smoked tobacco as an endgame initiative: a qualitative analysis. Tob Control 2024:tc-2023-058126. [PMID: 37940403 DOI: 10.1136/tc-2023-058126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Tobacco endgame strategies often include measures to reduce tobacco availability by decreasing retailer numbers. Recently, some US pharmacies have delisted tobacco, though overall retailer numbers have not reduced markedly. Paradoxically, others have suggested limiting tobacco sales to pharmacies, to reduce supply and support cessation. We explored how pharmacists from Aotearoa New Zealand, a country planning to reduce tobacco supply, perceived supplying tobacco. METHODS We undertook in-depth interviews with 16 pharmacists from Ōtepoti Dunedin; most served more deprived communities with higher smoking prevalence. We probed participants' views on supplying tobacco, explored factors that could limit implementation of this policy, and analysed their ethical positions. We used qualitative description to analyse data on limiting factors and reflexive thematic analysis to interpret the ethical arguments adduced. RESULTS Most participants noted time, space and safety concerns, and some had strong moral objections to supplying tobacco. These included concerns that supplying tobacco would contradict their duty not to harm patients, reduce them to sales assistants, undermine their role as health experts, and tarnish their profession. A minority focused on the potential benefits of a pharmacy supply measure, which they thought would use and extend their skills, and improve community well-being. CONCLUSIONS Policy-makers will likely encounter strongly expressed opposition if they attempt to introduce a pharmacy supply measure as an initial component of a retail reduction strategy. However, as smoking prevalence falls, adopting a health-promoting supply model, using pharmacies that chose to participate, would become more feasible and potentially enhance community outreach and cessation support.
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Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Charika Muthumala
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Elizabeth Fenton
- Bioethics Centre, University of Otago Bioethics Centre, Dunedin, New Zealand
| | - Coral E Gartner
- School of Public Health, University of Queensland, Herston, Queensland, Australia
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East K, Taylor E, Simonavičius E, Nottage M, Reid JL, Burkhalter R, Brose L, Wackowski OA, Liber AC, McNeill A, Hammond D. Noticing education campaigns or public health messages about vaping among youth in the United States, Canada and England from 2018 to 2022. HEALTH EDUCATION RESEARCH 2024; 39:12-28. [PMID: 38165724 PMCID: PMC10805379 DOI: 10.1093/her/cyad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 01/04/2024]
Abstract
Public health campaigns have the potential to correct vaping misperceptions. However, campaigns highlighting vaping harms to youth may increase misperceptions that vaping is equally/more harmful than smoking. Vaping campaigns have been implemented in the United States and Canada since 2018 and in England since 2017 but with differing focus: youth vaping prevention (United States/Canada) and smoking cessation (England). We therefore examined country differences and trends in noticing vaping campaigns among youth and, using 2022 data only, perceived valence of campaigns and associations with harm perceptions. Seven repeated cross-sectional surveys of 16-19 year-olds in United States, Canada and England (2018-2022, n = 92 339). Over half of youth reported noticing vaping campaigns, and noticing increased from August 2018 to February 2020 (United States: 55.2% to 74.6%, AOR = 1.21, 95% CI = 1.18-1.24; Canada: 52.6% to 64.5%, AOR = 1.13, 1.11-1.16; England: 48.0% to 53.0%, AOR = 1.05, 1.02-1.08) before decreasing (Canada) or plateauing (England/United States) to August 2022. Increases were most pronounced in the United States, then Canada. Noticing was most common on websites/social media, school and television/radio. In 2022 only, most campaigns were perceived to negatively portray vaping and this was associated with accurately perceiving vaping as less harmful than smoking among youth who exclusively vaped (AOR = 1.46, 1.09-1.97). Consistent with implementation of youth vaping prevention campaigns in the United States and Canada, most youth reported noticing vaping campaigns/messages, and most were perceived to negatively portray vaping.
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Affiliation(s)
- Katherine East
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, London SE5 8BB, UK
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Eve Taylor
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, London SE5 8BB, UK
| | - Erikas Simonavičius
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, London SE5 8BB, UK
| | - Matilda Nottage
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, London SE5 8BB, UK
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Robin Burkhalter
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Leonie Brose
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, London SE5 8BB, UK
| | - Olivia A Wackowski
- School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Alex C Liber
- Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Addictions Sciences Building, 4 Windsor Walk, London SE5 8BB, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
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Gómez Martínez JC, Gaztelurrutia Lavesa L, Mendoza Barbero A, Plaza Zamora J, Lage Piñón M, Aguiló Juanola M, Climent Catalá M, de Andrés Dirube A, García Moreno L, Jaraiz Magariños I, Moral Ajado M, Sánchez Marcos N. Smoking cessation intervention in the community pharmacy: Cost-effectiveness of a non-randomized cluster-controlled trial at 12-months' follow-up. Res Social Adm Pharm 2024; 20:19-27. [PMID: 37704533 DOI: 10.1016/j.sapharm.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND This study evaluated the cost-effectiveness of an intervention based on a training course for community pharmacists and a smoking cessation service (CESAR©), using limited societal and the health provider perspectives. METHODS Non-randomized controlled trial of 12-months' follow-up. Spanish community pharmacists who were previously trained with CESAR© formed the intervention group (n = 102), and control group delivered usual care (n = 80). CESAR Patients were smokers identified by the community pharmacists when they attended the pharmacy. Data were self-reported. Outcomes were smoking cessation and quality-of-life (EQ-5D-3L) and were collected at baseline, 6, and 12 months. Costs data included direct health costs, work loss, and intervention costs. Smoking cessation was analyzed through logistic regression models. Generalized linear models were carried out for quality-adjusted life year (QALY) and costs. Incremental cost-effectiveness ratio (ICER) and cost-utility ratio (ICUR) were calculated. RESULTS In total, 800 smoking patients were included in the intervention group and 278 in the control group. Of these, 487 and 151 patients completed the study, respectively. Costs were lower in the intervention group compared to the control group in both perspectives. At 12 months, 54.3% and 37.1% patients from the intervention and the control groups reported smoking cessation, respectively. The difference in probability of cessation in the intervention compared to the control group was 17.6% (CI:0.05; 0.25). The mean QALY was higher in the intervention group [0.03(CI: 0.01; 0.07)]. The ICER and the ICUR were dominant for the intervention group. CONCLUSION This intervention for smoking cessation showed that the CESAR© intervention, that combined a training for community pharmacists with a smoking cessation service was efficient for smoking cessation and QALY at 12 months' follow-up. TRIAL REGISTRATION NCT05461066, retrospectively registered (July 15, 2022).
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Affiliation(s)
- Jesús Carlos Gómez Martínez
- Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | - Leire Gaztelurrutia Lavesa
- Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain.
| | - Ana Mendoza Barbero
- Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | - Javier Plaza Zamora
- Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | - Montserrat Lage Piñón
- Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | - Miguel Aguiló Juanola
- Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | - Maite Climent Catalá
- Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | | | - Luís García Moreno
- Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | - Irene Jaraiz Magariños
- Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | - Montse Moral Ajado
- Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
| | - Navidad Sánchez Marcos
- Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain
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White D, Bush A, Smyth AR, Bhatt JM. Why and how should children be protected from the deluge of vaping related media and marketing overexposure? Breathe (Sheff) 2023; 19:230141. [PMID: 38125806 PMCID: PMC10729810 DOI: 10.1183/20734735.0141-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023] Open
Abstract
E-cigarettes are products delivering nicotine via inhalation and are devised to mimic tobacco smoking. While they were initially introduced as a device putatively to aid with smoking cessation, their use is now far broader than that. Use by children is significantly increasing. There is growing evidence of the potential harms of vaping. E-liquids used for e-cigarettes contain a wide range of harmful substances, and the clinical consequences of this are now being increasingly demonstrated, such as the rise in cases of e-cigarette- or vaping-associated lung injury. In addition, early use may result in long-term nicotine addiction. Vaping companies utilise marketing methods that distinctly target young people, and weak legislation in the UK allows them free rein to expose children to vaping. In this review we demonstrate why children must be protected from vaping. We must have stringent legislation to prevent easy access to e-cigarettes, including banning the convenience and affordability disposable vapes provide, and prevent marketing that does not warn about the potential health effects. The Australia approach of prescription or pharmacy only access for smoking cessation should be considered to limit exposure of children and minimise use by nonsmokers.
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Affiliation(s)
- David White
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, UK
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, National Heart and Lung Institute, London, UK
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Imperial Centre for Paediatrics and Child Health, London, UK
| | - Alan R. Smyth
- NIHR Biomedical Research Centre, Nottingham, UK
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Jayesh Mahendra Bhatt
- Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, UK
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Evans A, Mantzourani E, Gillespie D, Hughes L, Sharpe G, Yip N. Location, location, location: does providing public health services from community pharmacies contribute to tackling health inequalities? J Public Health (Oxf) 2023; 45:e478-e485. [PMID: 36502416 DOI: 10.1093/pubmed/fdac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/26/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Community pharmacies have long been advocated as an accessible source of advice on health improvement in communities. This cross-sectional study explored the association between provision of pharmacy public health services and factors that might influence the extent to which pharmacies contribute to tackling inequalities. METHODS Publically available data were used to explore the association between pharmacy public health service provision and pharmacy characteristics (socioeconomic deprivation, urbanity, opening hours and workload). Regression models were fitted to the number of service consultations. The association between the number of services provided and the mean number of consultations across each service was investigated using regression models. RESULTS Pharmacies showed a propensity for being situated in areas of higher socioeconomic deprivation. There was no association between socioeconomic deprivation and number of service consultations a pharmacy provided. Clustering of pharmacies in less affluent areas led to over half of all public health service consultations being in the two most deprived quintiles. CONCLUSIONS Providing healthcare services from pharmacies in more deprived areas does not mean the public use them or that pharmacies will prioritize their delivery. The higher prevalence of pharmacies in disadvantaged communities is an important factor in ensuring pharmacy services support reducing inequalities.
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Affiliation(s)
| | - Efi Mantzourani
- Health and Social Services Group, Welsh Government, Cardiff CF10 3NQ, UK
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff CF10 3AT, UK
| | - Louise Hughes
- Health and Social Services Group, Welsh Government, Cardiff CF10 3NQ, UK
| | - Georgia Sharpe
- Health and Social Services Group, Welsh Government, Cardiff CF10 3NQ, UK
| | - Nicola Yip
- Health and Social Services Group, Welsh Government, Cardiff CF10 3NQ, UK
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10
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Alzahrani F, Sandaqji Y, Alharrah A, Alblowi R, Alrehaili S, Mohammed-Saeid W. Community Pharmacies' Promotion of Smoking Cessation Support Services in Saudi Arabia: Examining Current Practice and Barriers. Healthcare (Basel) 2023; 11:1841. [PMID: 37444675 DOI: 10.3390/healthcare11131841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Community pharmacists' interventions have been found to be highly effective. However, to date, there has been little information about pharmacists' potential roles and perceived barriers to providing smoking cessation. This study aimed to assess the potential role of community pharmacists in supporting their patients to quit smoking by summarizing their self-reported level of current activities, confidence, and perceived barriers; Methods: A self-administered questionnaire was used for a cross-sectional study in Saudi Arabia. As part of the questionnaire, demographic characteristics were measured, as well as confidence, perceived berries, and level of smoking cessation activities (asking, advising, assessing, assisting, and arranging, including follow-up).; Results: 370 community pharmacists practicing responded to the survey. Pharmacists indicated high activity rates about advising and assessing patients in quitting smoking, with lower rates of assisting and arranging, including following up. The rate of recording smoking status was very low. There were significant differences between gender, source of education, years practicing as a licensed pharmacist, attended an education or training program on smoking cessation, and interest in providing smoking and perceived practice of smoking cessation. Pharmacists are confident about providing smoking cessation activities. Barriers to providing smoking cessation services include unable to follow up, lack of counseling space, lack of educational materials, and lack of time.; Conclusions: Saudi Arabian community pharmacists actively offer smoking cessation services, which may reduce smoking-related health issues. It appears that pharmacists need to be empowered by team-based, systematic, comprehensive approaches to overcome barriers and enhance their confidence.
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Affiliation(s)
- Fahad Alzahrani
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | - Yazeed Sandaqji
- College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | | | - Ramzi Alblowi
- College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | - Samer Alrehaili
- College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | - Waleed Mohammed-Saeid
- Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
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11
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Maier CB, Winkelmann J, Pfirter L, Williams GA. Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews. Int J Public Health 2023; 68:1605448. [PMID: 37228895 PMCID: PMC10203245 DOI: 10.3389/ijph.2023.1605448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Objectives: Skill-mix changes to step up health promotion and prevention are increasing, but there is limited evidence on their effects. Methods: Overview of reviews, based on a protocol. The search was carried out in six databases, screening was performed ensuring high interrater reliability. All countries, health professions and lay workers in all settings (except hospitals) were included, quality appraisals performed. Results: A total of 31 systematic reviews were included. Expanded roles performing outreach (e.g., home visits) had mostly positive effects on access and health outcomes, primarily for hard-to-reach groups. Task-shifting in colorectal or skin cancer screenings (performed by advanced practice nurses) were suggested effective; supporting roles (by community health workers) increased uptake in screenings, but based on limited evidence. Expanded roles of various professions focusing on lifestyle modification showed promising effects in most reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. Conclusion: Promising skill-mix changes included expanded roles providing lifestyle modifying interventions, task-shifting, and outreach roles for hard-to-reach groups, whereas evidence on costs was limited.
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Affiliation(s)
- Claudia Bettina Maier
- Department of Health Care Management, Faculty of Economics and Management, Technical University Berlin, Berlin, Germany
| | | | - Laura Pfirter
- Department of Health Care Management, Faculty of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Gemma A. Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom
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12
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Phillips LC, Nguyen H, Genge TL, Maddigan WJ. Effectiveness and cost-effectiveness of an intensive and abbreviated individualized smoking cessation program delivered by pharmacists: A pragmatic, mixed-method, randomized trial. Can Pharm J (Ott) 2022; 155:334-344. [DOI: 10.1177/17151635221128263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/27/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
Background: Tobacco use is the leading preventable cause of morbidity and mortality in Canada. Smoking cessation programs (SCPs) that are effective, cost-effective and widely available are needed to help smokers quit. Pharmacists are uniquely positioned to provide such services. This study compares the abstinence rates between 2 pharmacist-led SCPs and the cost-effectiveness between these and a comparator group. The study was conducted in St. John’s, Newfoundland and Labrador. Methods: This pragmatic, mixed-method trial randomized smokers to either an existing intensive SCP or a new abbreviated SCP designed for community pharmacies. The primary outcome was 6-month abstinence rates. Cost-effectiveness was determined using abstinence rates for the SCPs and a comparator group. Incremental costs per additional quit were calculated for the trial duration, and incremental costs per life-year gained were estimated over a lifetime. Results: Quit rates for the SCPs were 36% (intensive) and 22% (abbreviated) ( p = 0.199). Incremental costs per life-year gained for the SCPs were $1576 (intensive) and $1836 (abbreviated). The incremental costs per additional quit, relative to the comparator group, for the SCPs were $1217 (intensive) and $1420 (abbreviated). Discussion: Both SCPs helped smokers quit, and quit rates exceeded those reported for a comparator group that included a general population of adult smokers (~7%). The incremental costs per additional quit for both SCPs compare favourably to those reported for other initiatives such as quit lines and hospital-based interventions. Conclusion: Pharmacist-led smoking cessation programs are effective and highly cost-effective. Widespread implementation, facilitated by remuneration, has potential to lower smoking prevalence and associated costs and harms.
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13
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Hilts KE, Corelli RL, Vernon VP, Hudmon KS. Update and recommendations: Pharmacists' prescriptive authority for tobacco cessation medications in the United States. J Am Pharm Assoc (2003) 2022; 62:1531-1537. [PMID: 35953378 PMCID: PMC9464677 DOI: 10.1016/j.japh.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
To characterize state laws in the United States regarding the expansion of pharmacists' prescriptive authority for tobacco cessation medications, compare key components across different models, and discuss important considerations for states that are considering similar legislation or policies. Legislative language was reviewed and summarized for all states with pharmacist prescriptive authority for tobacco cessation medications, and state boards of pharmacy were contacted to determine the number of registered complaints or safety concerns received as a result of pharmacists' prescribing under these authorities. As of June 2022, 17 states have enacted laws for pharmacists' prescriptive authority for tobacco cessation medications; most (N = 16) have implemented procedures, and 1 is in the process of adopting a similar prescribing model. Of 16 states with fully delineated protocols, 8 (Colorado, Idaho, Indiana, New Mexico, North Dakota, Oregon, Utah, Vermont) include all medications approved by the U.S. Food and Drug Administration for smoking cessation, and 8 (Arizona, Arkansas, California, Iowa, Maine, Minnesota, Missouri, North Carolina) include nicotine replacement therapy medications only. Most protocols specify minimum cessation education requirements for pharmacists and define required intervention elements (e.g., screening, cessation intervention components, follow-up, and documentation requirements). Personal communications with state boards of pharmacy revealed no complaints or safety concerns regarding pharmacists' prescribing for cessation medications since these authorities were first implemented, in New Mexico, in 2004. The number of states with pharmacists' prescriptive authority for tobacco cessation medications has increased substantially in recent years. There have been no registered complaints or safety concerns since the inception of this expanded scope of practice. Although the profession has made meaningful progress, there are inconsistencies across states with respect to medications that are included and requirements for implementing tobacco cessation services, which may impede broader adoption.
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14
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Ng R, El-Den S, Stewart V, Collins JC, Roennfeldt H, McMillan SS, Wheeler AJ, O'Reilly CL. Pharmacist-led interventions for people living with severe and persistent mental illness: A systematic review. Aust N Z J Psychiatry 2022; 56:1080-1103. [PMID: 34560826 DOI: 10.1177/00048674211048410] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE People living with severe and persistent mental illness experience poorer physical health, often due to medication and preventable lifestyle factors, and exacerbated by barriers to accessing healthcare services. Pharmacists are well-positioned to improve the physical and mental health of this population. However, little is known about pharmacists' current practices when providing services to this population nor the impact of pharmacist-led interventions on consumer health outcomes. We undertook a systematic review to identify, describe and assess the effectiveness of pharmacist-led interventions for supporting people living with severe and persistent mental illness and the impact on consumer outcomes. METHODS MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts and ProQuest Dissertations and Theses were searched between January 1990 and April 2020. Full-text studies exploring pharmacist-led interventions in any setting for people living with severe and persistent mental illness were included. A risk of bias assessment was conducted. RESULTS A total of 37 studies were included. More than half of the pharmacist interventions were multifaceted. The most common components of pharmacist-led interventions included education and/or patient counselling, providing recommendations to healthcare professionals and conducting medication reviews. Multifaceted interventions demonstrated improvements in clinical outcomes, whereas single interventions focused mostly on consumer-reported outcomes. The methodological quality of included studies was moderate-to-high risk of bias and there was considerable heterogeneity in the study design, interventions described, and outcomes reported. CONCLUSION There is evidence that pharmacist-led interventions improve consumer-reported and clinical outcomes for people living with severe and persistent mental illness. Pharmacists are capable and have a role in supporting people living with severe and persistent mental illness, either individually or as interprofessional collaborators with other healthcare professionals. Future research should attempt to better understand which particular intervention components have the greatest impact and also evaluate the implementation and long-term sustainability of such interventions.
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Affiliation(s)
- Ricki Ng
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarira El-Den
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Victoria Stewart
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Jack C Collins
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Helena Roennfeldt
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.,Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Sara S McMillan
- Health Systems Menzies Health Institute Queensland, School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.,Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Claire L O'Reilly
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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15
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Cieri-Hutcherson NE, Lomakina A, Chilbert MR. Retrospective Study of Appropriate Primary Prevention in Postmenopausal Women Presenting with a Major Adverse Cardiovascular Endpoint (MACE). PHARMACY 2022; 10:pharmacy10050105. [PMID: 36136838 PMCID: PMC9498536 DOI: 10.3390/pharmacy10050105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Postmenopausal women may be at an increased risk for cardiovascular events. The postmenopausal transition represents a key time for implementation of preventative strategies to reduce the risk of cardiovascular disease. The objective of this study was to evaluate the appropriate use of primary prophylaxis of cardiovascular disease in this population and to determine if an opportunity exists for improvement in primary prevention prescribing. Methods: A single-center, retrospective study was conducted of postmenopausal women aged 45–60 years between 1 October 2019 and 30 April 2021 with a diagnosis of a new major adverse cardiovascular event (MACE). This study was approved by the University at Buffalo Institutional Review Board. Results: After application of inclusion and exclusion criteria, 231 patients were included and analyzed. Median age was 55 years; 66.6% white; median body mass index was 30.11 kg/m2; 30.3% history of diabetes; 51.1% current smokers; 82.3% with a primary care provider (PCP); 97.6% insured. Patients with diabetes, current smokers, and those without a PCP were more likely to have inappropriate primary prevention use than patients without diabetes, non-smokers, and with a PCP, respectively (78.7% vs. 51.3%, p = 0.0002; 57.6% vs. 42.4%, p = 0.0177; 73.7% vs. 56.0%, p = 0.0474). Specifically, current smokers, and those with diabetes had significantly more inappropriate use of aspirin and statins for primary prevention than non-smokers and patients without diabetes. Conclusions: This study observed the use of appropriate primary prevention therapies in postmenopausal women and found that an opportunity may exist to improve prescribing appropriate primary prevention therapies for certain groups, most notably in postmenopausal women with diabetes, smokers, uninsured, and those without a PCP.
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16
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Bridging the Gap in Tobacco Cessation Services: Utilizing Community Pharmacists to Facilitate Transitions of Care in the USA. J Gen Intern Med 2022; 37:2840-2844. [PMID: 35426008 PMCID: PMC9009499 DOI: 10.1007/s11606-022-07546-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/31/2022] [Indexed: 01/07/2023]
Abstract
Interprofessional strategies for promoting tobacco cessation lead to enhanced quit rates among patients; however, current approaches might not effectively support patients with their quit attempts after they are discharged from the hospital. This paper explores opportunities for interprofessional collaboration between health system-based providers and community pharmacists, as one proposed approach to bridging tobacco cessation services during transitions of care. Suggested strategies include (1) increasing other healthcare professionals' awareness of legislative advances that permit pharmacists to prescribe cessation medications in some states, and (2) encouraging bi-directional communication between health system-based and community-based providers, especially via integrated electronic health records. Community pharmacists can offer a convenient solution to obtain the post-discharge medication and counseling support that patients need to increase their chances of quitting for good. Additional steps are discussed to improve broadscale capacity of this service being provided in community pharmacies.
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17
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Price AD, Coffey M, Houston L, Cook PA. Evaluation of a pharmacy supported e-cigarette smoking cessation intervention in Northwest England. BMC Public Health 2022; 22:1326. [PMID: 35820869 PMCID: PMC9273914 DOI: 10.1186/s12889-022-13711-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Cigarette smoking cessation has been described as the world’s most important public health intervention. Electronic cigarettes are a relatively new tool for assisting smoking cessation but there is a lack of data on their efficacy. This article reports on a pharmacy supported e-cigarette smoking cessation intervention undertaken in a metropolitan area in the north of England. Methods Longitudinal mixed-methods evaluation incorporating analysis of secondary data, interviews with service users, and interviews with service providers at 3-month and 12-month follow-up, with an additional text message survey of service users at 12-month follow-up. Results The four-week follow-up data suggest that for every twenty people given an e-cigarette, six quit smoking tobacco and three people cut their cigarette intake by more than five cigarettes per day. Long-term follow-up results were positive but only a small number of participants were still engaged with the study at 12 months. Service users and providers spoke positively about the combination of e-cigarettes and pharmacy support. Conclusions E-cigarette distribution combined with pharmacy support appears to be an agreeable and effective intervention for smoking cessation, but further data are needed on long-term quit rates and health effects.
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Affiliation(s)
- Alan D Price
- School of Health and Society, University of Salford, Salford, UK
| | - Margaret Coffey
- School of Health and Society, University of Salford, Salford, UK
| | - Lawrence Houston
- School of Health and Society, University of Salford, Salford, UK
| | - Penny A Cook
- School of Health and Society, University of Salford, Salford, UK
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18
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Guthrie AR, Patel MA, Sweet CJ. Pharmacist-Assisted Varenicline Tobacco Cessation Treatment for Veterans. Fed Pract 2022; 39:304-309. [PMID: 36425350 PMCID: PMC9648582 DOI: 10.12788/fp.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Pharmacists are uniquely positioned to provide tobacco cessation interventions given their medication expertise and accessibility to the public. The purpose of this study was to evaluate the efficacy and safety of management of varenicline by clinical pharmacy specialists (CPSs) compared with other clinicians. METHODS This retrospective chart review included patients with a varenicline prescription between July 1, 2019, and July 31, 2020. Primary outcomes were reduction in tobacco use at 12 weeks from baseline, continuous abstinence at 12 weeks, adherence to varenicline therapy, and time to first follow-up. For safety evaluation, charts were reviewed for documented adverse drug reactions. RESULTS Management by CPS compared with other clinicians was associated with similar mean (SD) reductions of tobacco use (-7.9 [10.4] vs -5.4 [9.8] cigarettes per day, respectively; P = .15) and rates of complete abstinence (34% vs 38%, respectively; P = .73) and higher adherence (42% vs 31%, respectively; P = .01). Mean (SD) time to first follow-up was shorter for patients in the CPS group: 52 (66) vs 163 (110) days; P < .001. Adverse events were more common in the CPS group compared with the other clinicians group (42% vs 23%; P = .02). CONCLUSIONS These results suggest that CPS management of varenicline is as safe and effective as management by other clinicians. Additional research is needed to fully characterize the impact of pharmacist management of varenicline, justify expansion of CPS scope of practice, and ultimately enhance patient outcomes regarding tobacco cessation.
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19
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Corelli RL, Merchant KR, Hilts KE, Kroon LA, Vatanka P, Hille BT, Hudmon KS. Community pharmacy technicians' engagement in the delivery of brief tobacco cessation interventions: Results of a randomized trial. Res Social Adm Pharm 2022; 18:3158-3163. [PMID: 34544660 PMCID: PMC8898316 DOI: 10.1016/j.sapharm.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND In recent years, the role of community pharmacy technicians has expanded to include involvement in the provision of brief tobacco cessation interventions. While technicians appear to be a key component in this service, their level of engagement and associated perceptions of this new role have not been described. OBJECTIVE To compare pharmacy technicians' frequency of involvement in brief tobacco cessation interventions delivered in a community pharmacy setting, as a function of training approach, and to characterize their perceptions of this expanded role, including barriers to implementation. METHODS Twenty California-based grocery store chain pharmacies were randomized to receive (a) written training materials-only [minimal] or (b) written training materials plus live training with coaching and active monitoring by pharmacy management [intensive]. After written materials were distributed to the sites, tobacco cessation interventions were documented prospectively for 12 weeks post-training. RESULTS Over the 12-week study, technicians (n = 50) documented their involvement in 524 interventions (57.7% of 908 total), with the minimal group accounting for 56.1% and the intensive group accounting for 43.9% (p < 0.001). The number of individual technicians who reported at least one intervention was 16 (of 26; 61.5%) in the minimal group and 24 (of 24; 100%) in the intensive group (p < 0.001). At the conclusion of the study, 100% of technicians in the intensive group self-rated their ability to interact with patients about quitting smoking as good, very good, or excellent compared to 73.9% in the minimal group (p = 0.10). CONCLUSION In both study arms, technicians documented high numbers of tobacco cessation interventions. The higher proportion of technicians providing one or more interventions in the intensive group suggests a greater overall engagement in the process, relative to those receiving minimal training. Technicians can play a key role in the delivery of tobacco cessation interventions in community pharmacies.
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Affiliation(s)
- Robin L Corelli
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA.
| | - Kyle R Merchant
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA
| | - Katy Ellis Hilts
- Indiana University School of Nursing, Indianapolis, IN 46202, USA
| | - Lisa A Kroon
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA
| | - Parisa Vatanka
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA; American Pharmacists Association, Washington DC, 20037, USA
| | | | - Karen Suchanek Hudmon
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA; Purdue University College of Pharmacy, Indianapolis, IN 46202, USA
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20
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Implementing Brief Tobacco Cessation Interventions in Community Pharmacies: An Application of Rogers’ Diffusion of Innovations Theory. PHARMACY 2022; 10:pharmacy10030056. [PMID: 35736771 PMCID: PMC9230644 DOI: 10.3390/pharmacy10030056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023] Open
Abstract
Pharmacists, as highly accessible members of the healthcare team, have considerable potential to address tobacco use among patients. However, while published data suggest that pharmacists are effective in helping patients quit, barriers exist to routine implementation of cessation services in community pharmacy settings. Within the context of a randomized trial (n = 64 pharmacies), surveys were administered over a period of 6 months to assess pharmacists’ perceptions of factors associated with the implementation of “Ask-Advise-Refer”, a brief intervention approach that facilitates patient referrals to the tobacco quitline. Study measures, grounded in Rogers’ Diffusion of Innovations Theory, assessed pharmacists’ perceptions of implementation facilitators and barriers, perceptions of intervention materials provided, and perceived efforts and personal success in implementing Ask-Advise-Refer at 6-months follow-up. Findings indicate that while the brief intervention approach was not difficult to understand or implement, integration into normal workflows presents greater challenges and is associated with overall confidence and implementation success. Lack of time was the most significant barrier to routine implementation. Most (90.6%) believed that community pharmacies should be active in promoting tobacco quitlines. Study results can inform future development of systems-based approaches that lead to broad-scale adoption of brief interventions, including but not limited to tobacco cessation, in pharmacy settings.
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21
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Asayut N, Olson PS, Kanjanasilp J, Thanarat P, Senkraigul B, Sittisarn C, Suksawat S. A community pharmacist-led smoking cessation intervention using a smartphone app (PharmQuit): A randomized controlled trial. PLoS One 2022; 17:e0265483. [PMID: 35349576 PMCID: PMC8963551 DOI: 10.1371/journal.pone.0265483] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/01/2022] [Indexed: 01/10/2023] Open
Abstract
WHO supports the harnessing of mobile technologies to improve access to smoking cessation services. As such, this study evaluated the effectiveness of smoking cessation services provided by community pharmacists using PharmQuit compared with standard care. The study was a prospective, multicenter, randomized controlled trial that included 156 participants who were 18 years or older and smoked at least one cigarette daily for a month, were ready to quit, willing to participate, and had a smartphone. The study was performed at seven community pharmacies in three provinces in Thailand. Participants were allocated to the intervention (n = 78) and control groups (n = 78). Both groups received the usual smoking cessation services with pharmacotherapy and counseling from community pharmacists for 6 months. The intervention group received PharmQuit as an additional service. Both groups were scheduled for follow-up visits on days 7, 14, 30, 60, 120, and 180. The primary outcome was continuous abstinence rate on day 180. The secondary outcomes included 7-day point abstinence rate, number of cigarettes smoked per day, exhaled carbon monoxide levels, adherence rate to the program, and satisfaction with PharmQuit. An analysis using the intent-to-treat principle was performed. Smoking cessation rates and the number of cigarettes smoked per day were significantly higher during the follow-up visits in both groups (p < 0.05). However, there were no statistically significant differences between the two groups. The adherence rate to the smoking cessation program was higher in the intervention group than in the control group (74 days vs. 60 days, p > 0.05). The results showed the benefits of the contribution of community pharmacists. Although the inclusion of PharmQuit did not yield better results than pharmacists’ counselling alone, it may help obtain better adherence to smoking cessation programs. Trial registration: Thai Clinical Trials Registry: TCTR20200925004 on September 25, 2020 –retrospectively registered, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=6841.
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Affiliation(s)
- Narong Asayut
- Doctor of Philosophy in Pharmacy Program, Faculty of Pharmacy, Mahasarakham University, Khamriang Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Phayom Sookaneknun Olson
- The International Primary Care Practice Research Unit, Faculty of Pharmacy, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Juntip Kanjanasilp
- The Clinical Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Preut Thanarat
- Faculty of Informatics, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Bhattaraporn Senkraigul
- Faculty of Informatics, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Chuthathip Sittisarn
- The International Primary Care Practice Research Unit, Faculty of Pharmacy, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
| | - Suratsawatee Suksawat
- The International Primary Care Practice Research Unit, Faculty of Pharmacy, Mahasarakham University, Khamrieng Sub-District, Kantarawichai District, Maha Sarakham Province, Thailand
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22
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A Pragmatic Pilot Cluster-Randomized Study of Tobacco Screening and Smoking Cessation Program for Community Pharmacies in Japan: FINE Program. J Smok Cessat 2021; 2021:9983515. [PMID: 34956405 PMCID: PMC8664521 DOI: 10.1155/2021/9983515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives To investigate the effectiveness of a smoking cessation program (FINE program) in community pharmacies. Methods A cluster-randomized controlled trial was conducted in 11 community pharmacies in Japan. The participants were randomly assigned to a pharmacist-led structured smoking cessation program (intervention group) or pharmacist-led usual care (control group). The intervention group was followed up over the telephone on the third day of smoking cessation, and ongoing follow-up and advice were provided according to the original smoking cessation guidebook developed for the current study based on a behavioral change approach. The control group received brief advice and ready-made pamphlets on smoking cessation from pharmacists upon their visit to these community pharmacies. The primary outcome was continued smoking cessation as determined by self-reporting and carbon monoxide monitoring with a microsmokerlyzer after 3 months. Results Five hundred and seventy-two smokers who met the eligibility criteria visited the pharmacies included in the study. Of these individuals, 24 patients agreed to participate in the study. The quit rates were 45.5% and 18.2% in the intervention and control groups, respectively (P = 0.380, effect size = 0.60). Conclusion Based on the effect size values, the FINE program may be effective to some extent, but the difference was not significant. We speculate that this is related to the small sample size due to difficulty in recruiting. Further studies with an effective recruitment method and larger sample sizes are needed to accurately verify the effectiveness of this program.
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23
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Lertsinudom S, Kaewketthong P, Chankaew T, Chinwong D, Chinwong S. Smoking Cessation Services by Community Pharmacists: Real-World Practice in Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211890. [PMID: 34831660 PMCID: PMC8620368 DOI: 10.3390/ijerph182211890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to report the effectiveness of community pharmacy smoking cessation services in 13 health regions in Thailand using a retrospective data-collecting method from the Foundation of Community Pharmacy database. The participants were smokers aged at least 18 years. The outcomes were the abstinence of smoking at least 30 consecutive days by self-report only and self-report with exhaled CO level <7 ppm (if available), the number of cigarettes smoked daily, exhaled carbon monoxide (exhaled CO), and % peak expiratory flow rate (%PEFR); smokers measured these outcomes before and after receiving the smoking cessation services. Of 58 community pharmacies, 532 smokers (93% male, mean age of 42.4 ± 14.9 years) received smoking cessation services from community pharmacists. Of 235 smokers with complete data, 153 (28.8%, 153/532) smokers reported smoking abstinence by self-report. The mean number of cigarettes smoked daily reduced from 15.3 ± 8.7 to 1.9 ± 3.8 cigarettes, p-value < 0.001. The exhaled CO levels of smokers significantly reduced from 11.7 ± 5.9 ppm to 7.2 ± 4.4 ppm, p-value < 0.001. The %PEFR also significantly increased from 84.2 ± 19.4 to 89.5 ± 19.5, p-value < 0.001. In conclusion, Thai community pharmacy smoking cessation services could aid smokers to quit smoking. This study is the outcome of the real-world community pharmacy smoking cessation service; policymakers should consider this service to be included in the national healthcare policy.
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Affiliation(s)
- Sunee Lertsinudom
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand;
- Smoke Free Pharmacy Network, Community Pharmacy Foundation, Bangkok 10110, Thailand;
- Research and Training Center for Enhancing Quality of Life of Working-Age People, Faculty of Nursing, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pentipa Kaewketthong
- Smoke Free Pharmacy Network, Community Pharmacy Foundation, Bangkok 10110, Thailand;
| | | | - Dujrudee Chinwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand;
- Cluster of Excellence on Biodiversity-Based Economic and Society (B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
| | - Surarong Chinwong
- Smoke Free Pharmacy Network, Community Pharmacy Foundation, Bangkok 10110, Thailand;
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand;
- Cluster of Excellence on Biodiversity-Based Economic and Society (B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-53944342
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Edelman EJ, Dziura J, Deng Y, Bold KW, Murphy SM, Porter E, Sigel KM, Yager JE, Ledgerwood DM, Bernstein SL. A SMARTTT approach to Treating Tobacco use disorder in persons with HIV (SMARTTT): Rationale and design for a hybrid type 1 effectiveness-implementation study. Contemp Clin Trials 2021; 110:106379. [PMID: 33794354 PMCID: PMC8478961 DOI: 10.1016/j.cct.2021.106379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tobacco use disorder is a leading threat to the health of persons with HIV (PWH) on antiretroviral treatment and identifying optimal treatment approaches to promote abstinence is critical. We describe the rationale, aims, and design for a new study, "A SMART Approach to Treating Tobacco Use Disorder in Persons with HIV (SMARTTT)," a sequential multiple assignment randomized trial. METHODS In HIV clinics within three health systems in the northeastern United States, PWH with tobacco use disorder are randomized to nicotine replacement therapy (NRT) with or without contingency management (NRT vs. NRT + CM). Participants with response (defined as exhaled carbon monoxide (eCO)-confirmed smoking abstinence at week 12), continue the same treatment for another 12 weeks. Participants with non-response, are re-randomized to either switch medications from NRT to varenicline or intensify treatment to a higher CM reward schedule. Interventions are delivered by clinical pharmacists embedded in HIV clinics. The primary outcome is eCO-confirmed smoking abstinence; secondary outcomes include CD4 cell count, HIV viral load suppression, and the Veterans Aging Cohort Study (VACS) Index 2.0 score (a validated measure of morbidity and mortality based on laboratory data). Consistent with a hybrid type 1 effectiveness-implementation design and grounded in implementation science frameworks, we will conduct an implementation-focused process evaluation in parallel. Study protocol adaptations related to the COVID-19 pandemic have been made. CONCLUSIONS SMARTTT is expected to generate novel findings regarding the impact, cost, and implementation of an adaptive clinical pharmacist-delivered intervention involving medications and CM to promote smoking abstinence among PWH. ClinicalTrials.govidentifier:NCT04490057.
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Affiliation(s)
- E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States of America.
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Sean M Murphy
- CHERISH Center, Weill Cornell Medicine, New York, NY, United States of America
| | - Elizabeth Porter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Keith M Sigel
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jessica E Yager
- State University of New York Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - David M Ledgerwood
- Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America; Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America
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25
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Exploring the quality of smoking cessation in community pharmacies: A simulated patient study. Res Social Adm Pharm 2021; 18:2997-3003. [PMID: 34284972 DOI: 10.1016/j.sapharm.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking continues to be a major public health problem In the United Arab Emirates (UAE); the government has recently implemented policies to reduce smoking prevalence. Innovative strategies to support cessation are needed. Community pharmacies are vital venues to extend the reach and effectiveness of smoking cessation support. OBJECTIVE To evaluate the quality of community pharmacist smoking cessation counseling in the UAE. METHODS A cross-sectional, simulated patient (SP) study was conducted among N = 111 urban community pharmacies selected at random in Sharjah city. Two scenarios were developed to cover different types of cessation needs of treatment-seeking smokers and where pharmacists could have a major role in assisting with smoking cessation pharmacotherapy. The quality of pharmacist counseling was defined in terms of comprehensiveness and communication skills. Two formal assessment tools were used; an analytical checklist to assess the comprehensiveness of pharmacists smoking cessation counseling, and a global assessment form to evaluate communication skills. A descriptive analysis of the data was undertaken. RESULTS A total of 101 pharmacists participated in the study. Pharmacist assessment of smoking cessation-specific information and provision of counseling were minimal. Pharmacists most frequently assessed nicotine dependence and provided generic guidance on the use of nicotine replacement products (NRTs) to manage withdrawal, but they largely did not obtain relevant histories (e.g., medical/medication histories, previous quit attempts, smoking triggers), explain individualized management strategies (e.g., setting quit date, changing environment, reassurance and encouragement), or provide advice about ongoing support. Pharmacists attained low scores in verbal and nonverbal communication and were frequently unempathetic and judgmental towards female SPs. CONCLUSIONS Pharmacist-led smoking cessation programs can expand primary care-based cessation opportunities in the UAE and address the demand for cessation services. Pharmacists will benefit from additional training on the provision of smoking cessation interventions, with an emphasis on patient-centered communication skills.
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El Hajj MS, Sheikh Ali SAS, Awaisu A, Saleh R, Kheir N, Shami R. A pharmacist-delivered smoking cessation program in Qatar: an exploration of pharmacists' and patients' perspectives of the program. Int J Clin Pharm 2021; 43:1574-1583. [PMID: 34080087 PMCID: PMC8642383 DOI: 10.1007/s11096-021-01286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/24/2021] [Indexed: 10/28/2022]
Abstract
Background Tobacco use is one of the major causes of morbidity and mortality. An intensive pharmacist-delivered smoking cessation program was implemented in eight primary care pharmacies in Qatar. Objective This study aimed to qualitatively explore the perspectives of pharmacists and patients regarding their experiences in the program and their recommendations for improving it. Setting Primary care in Doha, Qatar. Method This study used a qualitative case study approach with semi-structured interviews of a sample of patients and pharmacists who participated in the program. Interviews were conducted between October 2016 and June 2017, were audio-recorded and transcribed verbatim. A thematic approach for data analysis was used. Main outcome measures Perspectives of pharmacists and patients. Results Pharmacists who delivered the program (n = 17) and patients who completed the program's outcomes assessment (n = 68) were invited through telephone call or email. Eight pharmacists and 22 patients were interviewed. Seven themes emerged: (1) both pharmacists and patients had positive experiences and both considered pharmacists as among the most suitable healthcare providers to provide smoking cessation interventions (2) both pharmacist and patient participants indicated that the program provided successful services (3) pharmacists identified several challenges for implementing the program including difficulty in motivating and in following-up patients, workplace barriers, communication and cultural barriers, (4) both pharmacists and patients perceived several barriers for quitting including lack of motivation to quit or to commit to the plan, high nicotine dependence, stress and personal problems (5) both pharmacists and patients considered several patient-related facilitators for quitting including development of smoking related complications, religious beliefs and external support; (6) use of smoking cessation medications was considered a program-related facilitator for quitting by patients whereas behavioral therapy was perceived to be a facilitator by pharmacists (7) pharmacists and patients proposed strategies for program improvement including enhancing pharmacist training and patient recruitment. Conclusion The program was perceived to be beneficial in helping patients quit smoking, and it positively contributed to advancing pharmacist role. The study findings can guide future development of successful pharmacist' smoking cessation programs in Qatar.
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Affiliation(s)
- Maguy Saffouh El Hajj
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health Qatar University, 2713, Doha, Qatar.
| | | | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health Qatar University, 2713, Doha, Qatar
| | - Rana Saleh
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health Qatar University, 2713, Doha, Qatar.,Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Nadir Kheir
- College of Pharmacy, Ajman University, Ajman, United Arab Emirates
| | - Rula Shami
- College of Health Sciences, QU Health Qatar University, 2713, Doha, Qatar
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Breen RJ, Frandsen M, Ferguson SG. Incentives for smoking cessation in a rural pharmacy setting: The Tobacco Free Communities program. Aust J Rural Health 2021; 29:455-463. [PMID: 34148279 DOI: 10.1111/ajr.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Investigate the smoking-related outcomes and feasibility of a pharmacy-led financial incentive program for smoking cessation. DESIGN Multi-site single-arm trial of the Tobacco Free Communities program. SETTING Community pharmacies within the Glamorgan Spring Bay (Site 1) and George Town (Site 2) municipalities of Tasmania. PARTICIPANTS Adult smokers. Based on funding, the recruitment target was 76 smokers. INTERVENTIONS Pharmacy staff provided quitting advice through 7 sessions over 3 months. At 6 sessions, abstinent participants (no cigarettes in the previous week and expired carbon monoxide ≤4 ppm) were rewarded with AU$50 vouchers. MAIN OUTCOME MEASURES Smoking-related outcomes were decreased smoking (self-reported cigarettes per day and carbon monoxide levels) and abstinence rates. Feasibility outcomes were meeting the recruitment target, participant retention and participants' views of the program (measured by interview data from Site 2). RESULTS Ninety individuals enrolled. Sixty-two participants were included in analyses; remaining participants were excluded from analyses because they did not consent to use of their data within this study or had carbon monoxide ≤4 ppm at enrolment. Smoking (carbon monoxide and cigarettes per day) significantly decreased between enrolment and the first financial incentive session. Twelve participants (19.35%) were abstinent at the end of the program. Yet retention was poor; only 13 participants (20.97%) attended all sessions. Interviews suggested participants found the program beneficial. CONCLUSIONS Providing financial incentive within rural community pharmacies could be a viable method of encouraging smoking reductions and quit attempts. Additional work is needed to increase retention and compare effects to usual care pharmacy practices.
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Affiliation(s)
- Rachel J Breen
- College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Mai Frandsen
- College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Stuart G Ferguson
- College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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Tse SS, Sands BE, Keefer L, Cohen BL, Maser E, Ungaro RC, Marion JF, Colombel JF, Itzkowitz SH, Gelman J, Dubinsky MC. Improved Smoking Cessation Rates in a Pharmacist-Led Program Embedded in an Inflammatory Bowel Disease Specialty Medical Home. J Pharm Pract 2021; 35:827-835. [PMID: 33827316 DOI: 10.1177/08971900211000682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cigarette smoking is associated with disease progression, poor outcomes, and increased biologic use in Crohn's Disease (CD). In this prospective study, we describe the structure and results of a pharmacist-driven smoking cessation program in an Inflammatory Bowel Disease (IBD) Specialty Medical Home. METHODS One pharmacist designed and implemented a collaborative drug therapy management (CDTM) program, which allowed the pharmacist to initiate and modify smoking cessation aids, monitor medication safety and efficacy, and provide behavioral counseling. Crohn's Disease patients who were current smokers and referred to the program were analyzed. Clinical and demographic data, disease activity, and smoking history were collected. The primary outcome was the proportion of patients in the enrolled group and the declined group who quit smoking at least once during the follow-up period. Secondary outcomes include demographic and clinical differences between enrolled and declined patients, and enrolled quitters and non-quitters. RESULTS Thirty-two patients were referred to the program and 19 participated. Over a median follow-up period of 305 [264-499] days, 42% (8/19) of enrolled patients quit smoking at least once. Fifteen percent (2/13) of declined patients quit smoking. Patients who continued to smoke had more instances of loss of response to a biologic, need to start a new biologic, or escalation of biologic therapy. The CDTM pharmacist was able to provide all necessary clinical services for smokers enrolled in the program. CONCLUSIONS A pharmacist-led smoking cessation program in a specialty medical home is feasible. It may result in successful quit attempts and may optimize IBD medication use.
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Tong V, Krass I, Luckie K, Aslani P. The evolving profile of cognitive pharmaceutical services in Australia. Res Social Adm Pharm 2021; 18:2529-2537. [PMID: 33992586 DOI: 10.1016/j.sapharm.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
Globally, the availability and delivery of cognitive pharmaceutical services (CPS) by pharmacists has expanded over time. Australia has been no exception to this trend, with government funding to support the provision of certain CPS significantly increasing over the last two decades. Whilst medication management services have been consistently funded by the government for more than 15 years, fluctuations in the funding of other CPS have been observed; for example, certain disease state management CPS and introduction of funded MedsChecks. Furthermore, legislative changes have broadened pharmacists' scope of practice and the CPS provided, contributing to an increase in user-pay services. Although the literature to date has highlighted positive impacts associated with CPS on economic, clinical and/or humanistic outcomes, context-specific, real world evidence for the benefits of CPS is much needed to ensure the profession engages in evidence-based practice. The aim of this commentary is to outline the changes in CPS provision and funding within the Australian context, the existing evidence for CPS, and highlight the implications for future research.
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Affiliation(s)
- Vivien Tong
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Ines Krass
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Kate Luckie
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
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Xiong S, Willis R, Lalama J, Farinha T, Hamper J. Perspectives and perceived barriers to pharmacist-prescribed tobacco cessation services in the community pharmacy setting. J Am Pharm Assoc (2003) 2021; 61:S39-S48. [PMID: 33483273 DOI: 10.1016/j.japh.2020.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/10/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE(S) Tobacco use is a leading cause of preventable morbidity and mortality in the United States. Community pharmacists are in an advantageous position to increase patient accessibility to tobacco cessation medications and counseling. Pharmacists are permitted to prescribe or furnish tobacco cessation medications in 13 states with varying requirements and limitations. The primary objective of this study was to evaluate the perspectives and perceived barriers that pharmacy personnel have in providing pharmacist-prescribed tobacco cessation services in the community pharmacy setting. The secondary objectives were to evaluate current practices of the 5 A's model and to identify additional training needed to provide the service. METHODS This study was a descriptive cross-sectional electronic survey of pharmacy personnel from a large grocery pharmacy chain. The respondents were asked about their demographics, current practices of the 5 A's model, perceived barriers and attitudes toward pharmacist-prescribed tobacco cessation services, and additional training needed to provide the service. RESULTS The survey received 79 responses from pharmacists. The results showed that 92.4% (73/79) of the respondents agreed that community pharmacists should provide tobacco cessation services. The biggest barrier identified was "lack of time during normal workflow to deliver tobacco cessation services" at 54.4% (43/79). Regarding the 5 A's model, 74.7% (59/79) of the pharmacists responded "never" or "somewhat infrequently" to how often they practice the "Ask" step, with other steps in the 5 A's model reported at similar frequencies. The top 3 additional trainings that the pharmacists identified were "strategies developing a follow-up plan with patients," "incorporating service into workflow," and "strategies providing counseling on tobacco cessation." CONCLUSION Efforts should be made to give community pharmacy personnel more time and guidance to provide patient care services beyond traditional dispensing roles to provide tobacco cessation services.
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Factors associated with the intensity of government remunerated and unremunerated service provision in community pharmacies. Res Social Adm Pharm 2020; 17:1614-1622. [PMID: 33423903 DOI: 10.1016/j.sapharm.2020.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/25/2020] [Accepted: 12/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many community pharmacies provide medication and disease state management services with and without specific remuneration. Availability of these services is often reported, however little is known about factors influencing the intensity of their provision. OBJECTIVE To investigate factors associated with the intensity of provision of selected government remunerated and unremunerated community pharmacy services in Western Australia (WA). METHODS A questionnaire was mailed to a random sample of 421/628 (67%) community pharmacies in WA. The first dependent variable was intensity of government remunerated MedsCheck and Diabetes MedsCheck service frequencies per month. The second was the intensity of the sum of government unremunerated asthma screening, blood glucose testing, cholesterol testing and smoking cessation disease state management service frequencies per week. Principal Component Analysis defined attitudinal components influencing service provision. Linear regression with bootstrap confidence intervals determined variables associated with intensity of provision of the selected services. The variables were: pharmacist; pharmacy setting characteristics; and, attitudinal factors. RESULTS The questionnaire yielded a response rate of 49.2%. Attitudinal components that facilitated service provision were: general practitioners (GPs) willingness to collaborate; pharmacists are capable and ready; and pharmacists require further training. Staff capability and low return on investment were barriers to increased service provision. The intensity of government remunerated services was independently associated with pharmacies having pharmacy interns, fewer dispensary technicians, and being capable and ready to provide the services. Higher intensity of the provision of the unremunerated disease state management services was independently associated with the intensity of provision of MedsCheck and Diabetes MedsCheck services. CONCLUSIONS Improved pharmacy workflow, achieved by the availability of pharmacy interns, and pharmacists being capable and ready, were important factors in the intensity of MedsCheck and Diabetes MedsCheck services. Intensity of the provision of government remunerated services facilitated a higher prevalence of disease state management services provision.
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Community pharmacists' perspectives about the sustainability of professional pharmacy services: A qualitative study. J Am Pharm Assoc (2003) 2020; 61:181-190. [PMID: 33262025 DOI: 10.1016/j.japh.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/30/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Pharmacists have been increasing patient-focused care through the implementation and provision of professional services. However, there is a lack of evidence on how to achieve long-term sustainability of the service once it is implemented. A framework identifying the factors affecting the sustainability of professional pharmacy services was developed. The objectives of this study were to explore the experiences of community pharmacists providing professional services to contextualize and assess the applicability in practice of the sustainability framework. METHODS A qualitative study was undertaken across Australia. Community pharmacists were identified using snowball sampling. Data were collected through semistructured interviews. Eighteen interviews were conducted and analyzed using framework methodology in NVivo 12 (QSR International). RESULTS A range of major sustainability factors was identified and organized in social, economic, and environmental domains. In the social domain, most of the interviewees stated the importance of motivating staff to increase service promotion and patients' demand. Most of the participants emphasized that having an adequate number of trained staff is required to enhance and maintain services over time. The perceived reluctance of some patients to spend more time than usual at the community pharmacy was another factor highlighted as affecting service sustainability. In the economic domain, the concern about lack of remuneration for service provision was highlighted by most of the interviewees. Having economic support was seen as essential for achieving sustainable services. In the environmental domain, the necessity of government recognition of the pharmacists' role and value to the health care system was identified as a new key sustainability driver. CONCLUSION The applicability of the framework for the sustainability of professional services was evaluated in practice. The identified factors will guide pharmacists to maintain implemented services and achieve their sustainability. Future research should focus on designing a tool to measure the sustainability of pharmacy services.
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Aguiar J, Ribeiro M, Pedro AR, Martins AP, da Costa FA. Awareness about barriers to medication adherence in cardiovascular patients and strategies used in clinical practice by Portuguese clinicians: a nationwide study. Int J Clin Pharm 2020; 43:629-636. [PMID: 33104948 DOI: 10.1007/s11096-020-01174-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although much is known about cardiovascular patients' medication adherence, the extent to which clinicians perceive non-adherence as a barrier in clinical practice is little explored. Objective To evaluate knowledge and awareness about potential barriers to medication adherence, and to evaluate strategies used in clinical practice by Portuguese clinicians on how to foster medication adherence of patients undergoing secondary cardiovascular prevention. Setting Nominal Group Technique (NGT) at the University of Lisbon; online survey addressed to physicians working in primary and secondary care in Portugal. Method A narrative literature review was conducted in Pubmed to identify studies describing interventions targeted at physicians to manage medication adherence. The NGT included 12 allied healthcare professionals with recognized expertise in medication adherence and was organised in four phases, resulting in survey development. The survey was used in a cross-sectional national study where clinicians reported their knowledge and perceptions about patients' medication adherence and their daily practice. Main outcome measures Knowledge and awareness about barriers to medication adherence; and practice patterns. Results A total of 296 papers were identified, 26 of which were included. Four main topics were selected to be used in the NGT: adherence determinants, detecting non-adherence, fostering adherence, and educating physicians. NGT resulted in a survey, reaching 451 physicians, mostly practicing in primary care. Most had specific education on medication adherence and considered patient interviews and prescription records the most useful assessment methods. Nonetheless, many recognised often using clinical judgement to evaluate adherence in practice. Barriers to medication adherence were perceived to occur often during implementation. Most perceived reasons for uncontrolled hypertension were non-adherence to lifestyle recommendations and to medication. Less than half the physicians asked their patients if medication was taken. More useful enabling strategies included reducing daily doses, reviewing therapeutic options and motivational interventions. Conclusions Clinicians seem well informed about the importance of medication adherence and aware of problems encountered in practice. Limited time during medical appointment may be a barrier for better patient support.
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Affiliation(s)
- João Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Manuel Ribeiro
- Environmental and Natural Resources Center (CERENA), University of Lisbon, Higher Technical Institute, Lisbon, Portugal
| | - Ana Rita Pedro
- National School of Public Health, Nova University of Lisbon, Research Group in Health Policy and Administration, Lisbon, Portugal
| | | | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal. .,Interdisciplinary Research Center Egas Moniz (CiiEM), University Institute Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal.
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Miller DR, Buettner-Schmidt K, Orr M, Rykal K, Niewojna E. A systematic review of refillable e-liquid nicotine content accuracy. J Am Pharm Assoc (2003) 2020; 61:20-26. [PMID: 33012670 DOI: 10.1016/j.japh.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The use of e-cigarettes is becoming more common in the United States. E-cigarettes are often refilled with nicotine-containing solutions of various concentrations purchased in local shops or on the Internet. There is evidence that the nicotine content in these solutions is often mislabeled; thus, we reviewed the available literature on this topic. DATA SOURCES We conducted a systematic review of peer-reviewed articles published worldwide on e-liquid nicotine content accuracy using the databases CAB Direct, Cochrane Central Register of Controlled Trials, PubMed, and SPORTDiscus (EBSCO). STUDY SELECTION Initial screening of titles and abstracts was conducted to determine relevancy for inclusion. Full-article reviews of studies involving the purchase and chemical analysis of nicotine content in refillable e-liquids were conducted for final inclusion. DATA EXTRACTION Data extraction included e-liquid sample size, whether the samples were labeled to contain nicotine, whether the samples were purchased in retail shops or online, and the number and percentage of samples where the analyzed nicotine content fell outside 10% of the labeled nicotine content. RESULTS Twenty articles described cross-sectional studies of purchased samples containing nicotine. The number of nicotine-containing e-liquid samples obtained in each study varied from 2 to 71. The percentage of samples with an analyzed nicotine concentration of more than 10% above or below the labeled nicotine concentration ranged from 0% to 100% (277/574 or 48.3%; median 46.85%). A large percentage of the samples deviated by 10% from the labeled nicotine concentrations in both U.S. and non-U.S. samples, with U.S. samples having a higher percentage. CONCLUSION Our review shows that actual nicotine concentrations in e-liquids may vary considerably from labeled concentrations. Pharmacists should warn patients to be wary of the contents of e-cigarettes, and explain the dangers of using these products.
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Beaupre LA, Hammal F, Stiegelmar R, Masson E, Finegan B. A community-based pharmacist-led smoking cessation program, before elective total joint replacement surgery, markedly enhances smoking cessation rates. Tob Induc Dis 2020; 18:78. [PMID: 33013274 PMCID: PMC7528266 DOI: 10.18332/tid/126405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/21/2020] [Accepted: 08/14/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION We compared smoking cessation outcomes between those who used a pharmacist-led community-based smoking cessation intervention and those who did not, prior to total joint replacement (TJR) surgery. Also, we examined intervention characteristics (e.g. number/duration of sessions attended, recommended therapy) and smoking cessation outcomes. METHODS This prospective evaluation was nested within a comparative study from a centralized clinic that prepares over 3000 patients annually for TJR and focused on participants referred to the community-based smoking cessation program preoperatively. Pharmacists offered an individualized evidence-based intervention and collected visit, duration and intervention data. Smoking cessation, the primary outcome, was ascertained independently of participating pharmacists at 6 weeks post-operative using exhaled CO monitoring and at 6 months post-recruitment via telephone interview. RESULTS Of 286 eligible candidates, 104 agreed to participate, with one subsequently withdrawing (n=103). At 6 weeks post-operatively, 66/103 (64%) participants returned for study re-assessment while 63/103 (61%) participants completed the post-recruitment interview at 6 months; non-respondents to study follow-up were considered smokers. Of 103 participants, 58 (56%) consulted with a pharmacist; those who did not consult a pharmacist (n=45) were slightly younger (p=0.02) with significantly higher CO level (p=0.02) on study entry. Validated 7-day point prevalence abstinence (PPA) at 6 weeks post-operative was 11/58 (19%) in pharmacist-compliant participants compared to 2/45 (4%) in non-compliant participants (p=0.04). At 6 months post-recruitment, 19/58 (33%) pharmacistcompliant participants self-reported a 7-day PPA compared to 2/45 (4%) by non-compliant participants (p<0.001). For pharmacist-compliant participants, 33/58 (54%) saw the pharmacist 4 times; the mean overall pharmacist time was 71.8±24.4 minutes/patient with 26/58 (45%) and 19/58 (33%) prescribed nicotine replacement therapy and varenicline, respectively, and 13/58 (22%) not using medication; post hoc analysis suggested varenicline was marginally more effective for smoking cessation than no medication (p=0.04). CONCLUSIONS Community-based pharmacist-led smoking cessation programs are an effective addition to usual preoperative care for smokers awaiting elective TJR. Using existing community resources led to higher smoking cessation rates in smokers waiting for TJR relative to those not using these resources.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada.,Department of Surgery, University of Alberta, Edmonton, Canada
| | - Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | | | - Edward Masson
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Barry Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
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Crilly P, Kayyali R. A Systematic Review of Randomized Controlled Trials of Telehealth and Digital Technology Use by Community Pharmacists to Improve Public Health. PHARMACY 2020; 8:E137. [PMID: 32759850 PMCID: PMC7559081 DOI: 10.3390/pharmacy8030137] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/31/2022] Open
Abstract
Community pharmacists (CPs) continue to have an important role in improving public health, however, advances in telehealth and digital technology mean that the methods by which they support their customers and patients are changing. The primary aim of this study was to identify which telehealth and digital technology tools are used by CPs for public health purposes and determine if these have a positive impact on public health outcomes. A systematic review was carried out using databases including PubMed and ScienceDirect, covering a time period from April 2005 until April 2020. The search criteria were the following: randomized controlled trials, published in English, investigating the delivery of public health services by community pharmacists using a telehealth or digital tool. Thirteen studies were included out of 719 initially identified. Nine studies detailed the use of telephone prompts or calls, one study detailed the use of a mobile health application, two studies detailed the use of a remote monitoring device, and one study detailed the use of photo-aging software. Public health topics that were addressed included vaccination uptake (n = 2), smoking cessation (n = 1), hypertension management (n = 2), and medication adherence and counseling (n = 8). More studies are needed to demonstrate whether or not the use of novel technology by CPs can improve public health.
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Affiliation(s)
| | - Reem Kayyali
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames KT1 2EE, UK;
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El-Den S, McMillan SS, Wheeler AJ, Ng R, Roennfeldt H, O'Reilly CL. Pharmacists' roles in supporting people living with severe and persistent mental illness: a systematic review protocol. BMJ Open 2020; 10:e038270. [PMID: 32665350 PMCID: PMC7359051 DOI: 10.1136/bmjopen-2020-038270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Severe and persistent mental illness (SPMI) can significantly impact a person's social, personal and professional life. Previous studies have demonstrated pharmacists' roles in mental healthcare; however, limited studies to date have focused on pharmacists' roles in providing healthcare services, specifically, to people living with SPMI. The aim of this systematic review is to explore the pharmacists' roles in providing support to people living with SPMI. METHODS AND ANALYSIS A systematic search will be conducted in Medline, Embase (Ovid), PsycINFO, CINAHL, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts and ProQuest Dissertations and Theses to identify potentially relevant primary research for inclusion. This will be guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist for systematic reviews. All primary research publications regardless of study design exploring or reporting on pharmacists' involvement in supporting people living with SPMI will be considered for inclusion. A tabular summary will be completed using data extracted from each included publication. Data synthesis and quality assessment methods will be chosen based on included study designs. ETHICS AND DISSEMINATION The results will be published in a peer-reviewed journal and used to inform the development of a pharmacist-specific training package to support people living with SPMI. PROSPERO REGISTRATION NUMBER CRD42020170711.
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Affiliation(s)
- Sarira El-Den
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sara S McMillan
- School of Pharmacy and Pharmacology, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
| | - Amanda J Wheeler
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Ricki Ng
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Helena Roennfeldt
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- The University of Melbourne Centre for Psychiatric Nursing, Carlton, Victoria, Australia
| | - Claire L O'Reilly
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Interest in Tobacco and Smoking Cessation Interventions Among Pharmacists and Student Pharmacists in a High Prevalence State. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carson‐Chahhoud KV, Livingstone‐Banks J, Sharrad KJ, Kopsaftis Z, Brinn MP, To‐A‐Nan R, Bond CM. Community pharmacy personnel interventions for smoking cessation. Cochrane Database Syst Rev 2019; 2019:CD003698. [PMID: 31684695 PMCID: PMC6822095 DOI: 10.1002/14651858.cd003698.pub3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Community pharmacists could provide effective smoking cessation treatment because they offer easy access to members of the community. They are well placed to provide both advice on the correct use of smoking cessation products and behavioural support to aid smoking cessation. OBJECTIVES To assess the effectiveness of interventions delivered by community pharmacy personnel to assist people to stop smoking, with or without concurrent use of pharmacotherapy. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, along with clinicaltrials.gov and the ICTRP, for smoking cessation studies conducted in a community pharmacy setting, using the search terms pharmacist* or pharmacy or pharmacies. Date of the most recent search: January 2019. SELECTION CRITERIA Randomised controlled trials of interventions delivered by community pharmacy personnel to promote smoking cessation amongst their clients who were smokers, compared with usual pharmacy support or any less intensive programme. The main outcome measure was smoking cessation rates at six months or more after the start of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane for study screening, data extraction and management. We conducted a meta-analysis using a Mantel-Haenszel random-effects model to generate risk ratios (RRs) and 95% confidence intervals (CIs). MAIN RESULTS We identified seven studies including 1774 participants. We judged three studies to be at high risk of bias and four to be at unclear risk. Each study provided face-to-face behavioural support delivered by pharmacy staff, and required pharmacy personnel training. Typically such programmes comprised support starting before quit day and continuing with weekly appointments for several weeks afterwards. Comparators were either minimal or less intensive behavioural support for smoking cessation, typically comprising a few minutes of one-off advice on how to quit. Participants in both intervention and control arms received equivalent smoking cessation pharmacotherapy in all but one study. All studies took place in high-income countries, and recruited participants visiting pharmacies. We pooled six studies of 1614 participants and detected a benefit of more intensive behavioural smoking cessation interventions delivered by community pharmacy personnel compared with less intensive cessation interventions at longest follow-up (RR 2.30, 95% CI 1.33 to 3.97; I2 = 54%; low-certainty evidence). AUTHORS' CONCLUSIONS Community pharmacists can provide effective behavioural support to people trying to stop smoking. However, this conclusion is based on low-certainty evidence, limited by risk of bias and imprecision. Further research could change this conclusion.
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Affiliation(s)
- Kristin V Carson‐Chahhoud
- University of South AustraliaSchool of Health SciencesCity East Campus, Frome RoadAdelaideAustralia5001
| | | | - Kelsey J Sharrad
- University of South AustraliaSchool of Health SciencesCity East Campus, Frome RoadAdelaideAustralia5001
| | - Zoe Kopsaftis
- The Queen Elizabeth Hospital, Central Adelaide Local Health NetworkRespiratory Medicine UnitAdelaideAustralia
| | - Malcolm P Brinn
- The University of QueenslandHabit Research Group, School of Public HealthPublic Health Building, Herston RoadHerston RoadBrisbaneQueenslandAustralia4030
| | - Rachada To‐A‐Nan
- The University of South AustraliaSchool of Pharmacy and Medical ScienceAdelaideAustralia
- The Basil Hetzel Institute for Translational Health ResearchTherapeutics Research Centre, School of Pharmacy and Medical SciencesWoodville SouthAustralia
| | - Christine M Bond
- University of AberdeenDivision of Applied Health SciencesPolwarth BuildingForesterhillAberdeenUKAB25 2ZD
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The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Prev Med 2019; 124:98-109. [PMID: 30959070 DOI: 10.1016/j.ypmed.2019.04.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/13/2019] [Accepted: 04/03/2019] [Indexed: 01/08/2023]
Abstract
Community pharmacies have great potential to deliver services aimed at promoting health and preventing disease, and are well placed in deprived communities. This review of reviews aimed to assess the effectiveness of community pharmacy-delivered public health services and assess how they impact on inequalities in health using PROGRESS-Plus characteristics. Twenty databases were searched from their start date until January 2018. The quality of the included articles was determined using the Assessment of Multiple Systematic Reviews tool (AMSTAR 2). Fifteen systematic reviews were identified reporting 157 unique primary studies. There were a number of community pharmacy initiatives with positive intervention effects on health outcomes. These services were predominantly focused on primary disease prevention, and included smoking cessation, weight management programmes, syringe exchange programmes, and inoculation services. This review supports the development of some community pharmacy public health services. At present, little is known how community pharmacy-delivered public health interventions impact on health inequalities. It would be prudent for future studies to address this by explicitly reporting outcomes according to the PROGRESS-Plus framework. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42017056264.
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Hunter A, Bobak A, Anderson C. A survey of smoking cessation training within UK pharmacy education. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:696-701. [PMID: 31227092 DOI: 10.1016/j.cptl.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/19/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Tobacco smoking is a significant public health problem, and remains the leading cause of preventable, premature death in the United Kingdom (UK). In order to reduce the burden of smoking in the UK, all healthcare professionals should be able to advise smokers how to quit and assist them to do so. The aim was to identify the extent of smoking cessation teaching and examination in UK pharmacy schools. METHODS A short survey of smoking cessation was sent to each Programme Director for all UK pharmacy schools (n = 29). RESULTS The survey achieved a response rate of 72%. All schools dedicated time teaching smoking cessation interventions, with 76% spending more than three hours, and 90% examining students on some aspect of smoking cessation. All schools taught about nicotine replacement therapy (NRT) and the role of behavioural support. At least 90% of schools taught about the role of the stop smoking services and opportunistic brief interventions, e.g., very brief advice (VBA). Only 14% covered practical delivery in clinical settings. CONCLUSIONS UK pharmacy schools are teaching and examining students on a wide range of smoking cessation interventions, including VBA. However, there was a lack of training reported on the management of mental health patients who smoke, and practical skills training. All schools should do more to ensure they are providing practical skills training to enable students to be adequately prepared for delivering smoking cessation support to all smokers, including vulnerable populations.
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Affiliation(s)
- Abby Hunter
- Division of Epidemiology and Public Health, University of Nottingham, C109, Clinical Sciences Building, Nottingham City Hospital, NG5 1PB, UK.
| | - Alex Bobak
- GPSI Smoking Cessation, Wandsworth Medical Centre, London SW18 4DD, UK
| | - Claire Anderson
- Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK
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Abstract
AbstractIntroductionRoles for pharmacists in general practice are developing in Australia. It is known that pharmacists can provide effective smoking cessation services in other settings but evidence in general practice is lacking.AimTo determine whether a pharmacist can provide effective smoking cessation services within general practice.MethodData from smoking cessation consultations were obtained for 66 consecutive patients seen by one practice pharmacist. The pharmacist tailored interventions to the individual. Medication was offered in collaboration with community pharmacists and general practitioners. Quit coaching, based on motivational interviewing, was conducted. Smoking status was ascertained at least 6 months after the intended quit date and verified by a carbon monoxide breath test where possible.ResultsThe patients’ median age was 43 years (range 19–74 years); 42 were females (64%). At baseline, the median (i) number of pack years smoked was 20 (range: 1–75); (ii) Fagerstrom Test of dependence score was 6 (1–10); and (iii) number of previous quit attempts was 3 (0–10). Follow-up after at least 6 months determined a self-reported point prevalence abstinence rate of 30% (20/66). Of all patients who reported to be abstinent, 65% (13/20) were tested for carbon monoxide breath levels and were all below 7 ppm. The biochemically verified smoking abstinence rate was therefore 20% overall (13/66). Successful quit attempts were associated with varenicline recommendation (69% v 25%), increased median number of practice pharmacist consultations (4 v 2 per patient) and mental health diagnosis (85% v 51%).ConclusionOur observed abstinence rate was comparable or better than those obtained by practice nurses, community pharmacists and outpatient pharmacists, indicating the general practice pharmacist provided an effective smoking cessation intervention. A larger randomised trial is warranted.
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Erku DA, Gartner CE, Do JT, Morphett K, Steadman KJ. Electronic nicotine delivery systems (e-cigarettes) as a smoking cessation aid: A survey among pharmacy staff in Queensland, Australia. Addict Behav 2019; 91:227-233. [PMID: 30224155 DOI: 10.1016/j.addbeh.2018.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/05/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study examined views of pharmacy staff regarding the safety of e-cigarettes compared to nicotine replacement therapies (NRTs) and conventional cigarettes, as well as views on their regulation in Australia. METHODS We conducted a cross-sectional survey among pharmacy staff (64 pharmacists and 76 pharmacy assistants) from the greater Brisbane region, Queensland, Australia. The self-administered questionnaire included closed- and open-ended questions that explores pharmacy staff perception on harms of e-cigarettes versus NRT and traditional cigarettes, knowledge of current e-cigarette regulations, views on how they should be regulated and information needs regarding e-cigarettes. Pearson's chi-square test was employed for computing differences between variables. A content analysis of responses to open-ended questions was also performed. RESULTS Over 90% of pharmacy staff regarded e-cigarettes without nicotine and NRTs as less harmful than regular tobacco cigarettes. This reduced to 72% for e-cigarettes containing nicotine, with 24% of respondents believing they are equally as harmful as conventional cigarettes. Moreover, few respondents were confident about the short and long term safety of e-cigarettes containing nicotine (36% and 15% respectively) whereas pharmacy staff were more comfortable with the safety of NRTs for short (88%) and long term (35%) use. The majority of respondents believed that e-cigarettes with nicotine should be regulated as a medicine, either requiring a prescription (24%) or sold only by pharmacies (22%), though many believed that they should be regulated in the same way as regular tobacco cigarettes (27%). Some pharmacy staff (39%) reported having been asked about e-cigarettes by customers and 75% believed that their customers would be interested in using e-cigarettes as a smoking cessation aid. CONCLUSIONS There is a need to provide evidence-based and customised education for pharmacists regarding e-cigarettes to help them guide their clients.
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Beaupre LA, Hammal F, DeSutter C, Stiegelmar RE, Masson E, Finegan BA. Impact of a standardized referral to a community pharmacist-led smoking cessation program before elective joint replacement surgery. Tob Induc Dis 2019; 17:14. [PMID: 31582925 PMCID: PMC6751968 DOI: 10.18332/tid/101600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Smokers undergoing total joint replacement (TJR) are more likely to develop infections and be re-admitted than non-smokers. The primary purpose of this study was to evaluate the effectiveness of standardized preoperative referral to a community-based pharmacist-led smoking cessation program compared to usual care for patients undergoing TJR. Secondarily, we evaluated the use of the smoking cessation program. METHODS A pre-post quasi-experimental study was conducted at a central intake clinic that prepares approximately 3000 TJR patients annually. Participants were recruited at a mean of 13±11.1 weeks preoperatively and provided informed consent. Participants in the ‘pre’ observational phase (OP) received usual care for smoking cessation. For ‘post’ intervention phase (IP) participants, a referral was sent to a community-based pharmacist-led smoking cessation program. Smoking status was validated on study entry using exhaled carbon monoxide. Participants’ smoking status was re-assessed using self-reported point prevalence abstinence at 6 months post-recruitment. RESULTS We enrolled 120/150 (80%) potential OP candidates and 104/286 (36%) potential IP candidates. The groups were similar on study entry; overall, the mean age of participants was 58.7±9.1 years and 103 (47%) were male. They reported medium nicotine dependence with 37±11.6 mean years smoked. At 6 months post-recruitment, 8 (7%) OP participants self-reported 30-day point prevalence abstinence compared to 21 (20%) IP participants (p=0.003). Only 58 (56%) IP participants complied with the pharmacist referral, with 19 (33%) of those seeing the pharmacist reporting point prevalence abstinence at 6 months compared to only 2 (4%) of the 45 participants who did not see the pharmacist (p<0.001). CONCLUSIONS Referral to a community smoking cessation program as preoperative standard of care is feasible and can enhance long-term quit rates, but voluntary participation led to low recruitment to the program.
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Affiliation(s)
- Lauren A Beaupre
- Collaborative Orthopaedic Research (CORe), Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Chrisopher DeSutter
- Collaborative Orthopaedic Research (CORe), Department of Surgery, University of Alberta, Edmonton, Canada
| | - Robert E Stiegelmar
- Collaborative Orthopaedic Research (CORe), Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward Masson
- Collaborative Orthopaedic Research (CORe), Department of Surgery, University of Alberta, Edmonton, Canada
| | - Barry A Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
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Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? INTEGRATED PHARMACY RESEARCH AND PRACTICE 2019; 8:1-11. [PMID: 30788283 PMCID: PMC6366352 DOI: 10.2147/iprp.s133088] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of death globally. This article explores the evidence surrounding community pharmacist interventions to reduce cardiovascular events and related mortality and to improve the management of CVD risk factors. We summarize a range of systematic reviews and leading randomized controlled trials and provide critical appraisal. Major observations are that very few trials directly measure clinical outcomes, potentially owing to a range of challenges in this regard. By contrast, there is an extensive, high-quality evidence to suggest that improvements can be achieved for key CVD risk factors such as hypertension, dyslipidemia, tobacco use, and elevated hemoglobin A1c. The heterogeneity of interventions tested and considerable variation of the context under which implementation occurred suggest that caution is warranted in the interpretation of meta-analyses. It is highly important to generate evidence for pharmacist interventions in developing countries where a majority of the global CVD burden will be experienced in the near future. A growing capacity for clinical registry trials and data linkage might allow future research to collect clinical outcomes data more often.
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Affiliation(s)
- Kevin Mc Namara
- School of Medicine, Deakin University, Geelong, VIC, Australia,
- Deakin Health Economics, Centre for Population Health, Deakin University, Geelong, VIC, Australia,
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
| | - Hamzah Alzubaidi
- Institute for Medical Research and College of Pharmacy, University of Sharjah, Sharjah, Sharjah, United Arab Emirates
| | - John Keith Jackson
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
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Erku DA, Hailemeskel B, Netere AK, Belachew SA. Pharmacist-led smoking cessation services in Ethiopia: Knowledge and skills gap analysis. Tob Induc Dis 2019; 17:01. [PMID: 31582913 PMCID: PMC6751994 DOI: 10.18332/tid/99573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/07/2018] [Accepted: 11/04/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The present study's objectives were: 1) assess the knowledge and attitude of pharmacists and pharmacy students regarding smoking/smoking cessation, and 2) document the extent of community pharmacists' involvement in the provision of smoking cessation services in Ethiopia. METHODS This study used cross-sectional and direct observation methods. A series of questionnaires were administered to final-year pharmacy students and practising pharmacists. Two scenarios simulating tobacco use in pregnancy and cardiovascular patients were selected and played by two well-trained simulated patients (SPs). Findings were analysed and presented using mean total scores, analysis of variances and independent sample t-test. RESULTS A total of 410 participants (213 out of 238 pharmacy students, response rate 89.5%; 197 out of 361 pharmacists, response rate 54.6%) completed the survey. Both pharmacy students and practising pharmacists had positive attitudes towards smoking cessation, and both groups had similar mean knowledge scores. A total of 80 simulated visits were conducted. Recipients of training on smoking cessation had significantly higher mean knowledge and attitude scores compared with those who did not receive such training. The majority of the pharmacists demonstrated poor in history-taking practice, and seldom assessed the patients' nicotine dependence level. Nicotine replacement therapies (NRTs) were supplied in only 10 of the visits and suggested, but not dispensed, in 35 of the visits. On the other hand, pharmacists in 59 visits counselled patients to visit addiction specialists and physicians. CONCLUSIONS The present study revealed the presence of significant clinical knowledge gaps and inadequate skills among pharmacists regarding smoking cessation services. Educating pharmacists about smoking cessation support as part of their continuous professional development and providing a hands-on customised educational intervention, such as practice guidelines in the form of an Ask-Advise-Refer approach, about smoking cessation will be useful.
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Affiliation(s)
- Daniel Asfaw Erku
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Bisrat Hailemeskel
- Department of Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, United States
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El Hajj MS, Awaisu A, Kheir N, Mohamed MHN, Haddad RS, Saleh RA, Alhamad NM, Almulla AM, Mahfoud ZR. Evaluation of an intensive education program on the treatment of tobacco-use disorder for pharmacists: a study protocol for a randomized controlled trial. Trials 2019; 20:25. [PMID: 30621772 PMCID: PMC6324165 DOI: 10.1186/s13063-018-3068-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tobacco use is presently responsible for the death of over seven million people across the world. In Qatar, it is one of the main causes of premature deaths and preventable diseases. To reduce tobacco use, Qatar has ratified the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) and has implemented many tobacco-control initiatives. In spite of these measures, tobacco use is still considered a public health threat in Qatar. Pharmacists practicing in retail/community pharmacy settings are often the first port of call for individuals requiring general health advice. Evidence has proven that they have a pivotal role in health promotion and disease prevention including tobacco cessation. However, pharmacists in Qatar are not actively involved in tobacco control and many have not received any education or training about smoking cessation counseling in the past. In an effort to build the capacity of pharmacists towards tobacco control in Qatar, the aim of the proposed study is to design, implement, and evaluate an intensive education program on tobacco dependence treatment for pharmacists in Qatar. METHODS/DESIGN The study will be a prospective randomized controlled trial comparing an intensive tobacco-related education program versus non-tobacco-related training on pharmacists' tobacco-use-related knowledge, attitudes, self-efficacy, and skills. Community pharmacists practicing in Qatar will be eligible for participation in the study. A random sample of pharmacists will be selected for participation. Consenting participants will be randomly allocated to intervention or control groups. Participants in the intervention group will receive an intensive education program delivered by a multi-disciplinary group of educators, researchers, and clinicians with expertise in tobacco cessation. A short didactic session on a non-tobacco-related topic will be delivered to pharmacists in the control group. The study has two primary outcomes: post-intervention tobacco-related knowledge and post-intervention skills for tobacco cessation assessed using a multiple-choice-based evaluation instrument and an Objective Structured Clinical Examination (OSCE), respectively. The secondary study outcomes are post-intervention attitudes towards tobacco cessation and self-efficacy in tobacco-cessation interventions assessed using a survey instrument. An additional secondary study outcome is the post-intervention performance difference in relation to tobacco-cessation skills in the practice setting assessed using the simulated client approach. DISCUSSION If demonstrated to be effective, this education program will be considered as a model that Qatar and the Middle East region can apply to overcome the burden of tobacco-use disorder. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03518476 . Registered on 8 May 2018. Version 1/22 June 2018.
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Affiliation(s)
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, 2713 Qatar
| | - Nadir Kheir
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | | | | | - Ahmad Mohd Almulla
- Tobacco Control Center-WHO Collaborating Center, Hamad Medical Corporation, Doha, Qatar
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Sherman JJ, Smith BL. Effect of a smoking cessation educational intervention on knowledge and confidence of pharmacy students versus community leaders. Pharm Pract (Granada) 2019; 17:1302. [PMID: 31015867 PMCID: PMC6463408 DOI: 10.18549/pharmpract.2019.1.1302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 02/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Training programs of various intensities and durations have been implemented
to assist healthcare providers and students in leading smokers in a quit
attempt. While some training programs have been developed to help community
leaders provide these services, the focus for community leaders has been to
assist with recruitment efforts. Objective: The objective of this study was to compare knowledge and confidence of
students and community members before and after a smoking cessation
educational intervention. Methods: After approval from the institutional review board, pharmacy students and
community members were recruited for two-hour educational interventions.
Topics covered included smoking health risks, benefits of quitting,
behavioral, cognitive, and stress-management techniques, smoking cessation
medications, and how to start a formal class. Pre- and post-intervention
survey instruments were given to all participants with comparisons made via
Student’s or Paired T-tests, as appropriate. Results: Knowledge scores increased significantly (p<0.05) after the
educational intervention for pharmacy students (n=30) and community members
(n=8). Confidence scores increased significantly for pharmacy students
(p<0.05), but not for community members. Pharmacy students had
significantly greater knowledge score changes (53.7%,
pre-intervention; 81.8%, post-intervention; p<0.05) versus
community members (32.1%, pre-intervention; 50.1%,
post-intervention; p<0.05). When comparing individual confidence
questions, only scores evaluating the change in confidence for providing
counseling were higher for students versus community members (2.13 vs. 1.8,
respectively; p<0.05). Conclusions: Pharmacy students and community leaders exhibited increased knowledge after a
smoking cessation educational intervention, and pharmacy students had
increased confidence scores. All confidence scores did not change
significantly for community members. Developing coalitions between
healthcare providers and community leaders, focusing on the roles of each,
may be productive in initiating smoking cessation programs.
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Affiliation(s)
- Justin J Sherman
- Associate Professor of Pharmacy Practice. School of Pharmacy, University of Mississippi. Jackson, MS (United States).
| | - Brett L Smith
- Clinical Instructor of Pharmacy Practice. School of Pharmacy, University of Mississippi. Jackson, MS (United States).
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Petrović-van der Deen FS, Blakely T, Kvizhinadze G, Cleghorn CL, Cobiac LJ, Wilson N. Restricting tobacco sales to only pharmacies combined with cessation advice: a modelling study of the future smoking prevalence, health and cost impacts. Tob Control 2018; 28:643-650. [PMID: 30413563 DOI: 10.1136/tobaccocontrol-2018-054600] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Restricting tobacco sales to pharmacies only, including the provision of cessation advice, has been suggested as a potential measure to hasten progress towards the tobacco endgame. We aimed to quantify the impacts of this hypothetical intervention package on future smoking prevalence, population health and health system costs for a country with an endgame goal: New Zealand (NZ). METHODS We used two peer-reviewed simulation models: 1) a dynamic population forecasting model for smoking prevalence and 2) a closed cohort multi-state life-table model for future health gains and costs by sex, age and ethnicity. Greater costs due to increased travel distances to purchase tobacco were treated as an increase in the price of tobacco. Annual cessation rates were multiplied with the effect size for brief opportunistic cessation advice on sustained smoking abstinence. RESULTS The intervention package was associated with a reduction in future smoking prevalence, such that by 2025 prevalence was 17.3%/6.8% for Māori (Indigenous)/non-Māori compared to 20.5%/8.1% projected under no intervention. The measure was furthermore estimated to accrue 41 700 discounted quality-adjusted life-years (QALYs) (95% uncertainty interval (UI): 33 500 to 51 600) over the remainder of the 2011 NZ population's lives. Of these QALYs gained, 74% were due to the provision of cessation advice over and above the limiting of sales to pharmacies. CONCLUSIONS This work provides modelling-level evidence that the package of restricting tobacco sales to only pharmacies combined with cessation advice in these settings can accelerate progress towards the tobacco endgame, and achieve large population health benefits and cost-savings. :.
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Affiliation(s)
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand.,Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
| | - Christine L Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
| | - Linda J Cobiac
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
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Buss VH, Shield A, Kosari S, Naunton M. The impact of clinical services provided by community pharmacies on the Australian healthcare system: a review of the literature. J Pharm Policy Pract 2018. [DOI: 10.1186/s40545-018-0149-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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