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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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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: 2] [Impact Index Per Article: 2.0] [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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Birarra MK, Baye E, Tesfa W, Kifle ZD. Knowledge of cardiovascular disease risk factors, practice, and barriers of community pharmacists on cardiovascular disease prevention in North West Ethiopia. Metabol Open 2022; 16:100219. [DOI: 10.1016/j.metop.2022.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/01/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
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Laborne-e-Valle MEP, Ahouagi AEDO, Braga DG, Pinto IVL, Lara-Júnior CR, Ferreira SG, Blunk PDFF, Reis AMM, Reis EA, Ramalho-de-Oliveira D, do Nascimento MMG. Assessment of Pharmaceutical Services for Smoking Cessation: An Effectiveness-Implementation Hybrid Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912305. [PMID: 36231605 PMCID: PMC9566807 DOI: 10.3390/ijerph191912305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/18/2022] [Accepted: 09/24/2022] [Indexed: 05/28/2023]
Abstract
Smoking is the main preventable cause of illness and early death worldwide. Thus, it is better to promote smoking cessation than to treat tobacco-related diseases. The objective of this study was to assess the implementation and effectiveness of smoking cessation pharmaceutical services offered in primary health care (PHC) in a large Brazilian city through a type 1 effectiveness-implementation hybrid study. The services were offered through individual or group approaches (Jan/2018-Dec/2019). The service indicators were described and the incidence of cessation in the services was evaluated. Factors associated with cessation were assessed by Poisson regression analysis. The services were offered in most PHC centers (61.2%) and by most pharmacists (81.3%). In total, 170 individual (9.7%) and 1591 group (90.3%) approaches occurred, leading to cessation in 39.4% (n = 67) and 44.8% (n = 712) of these, respectively. The use of nicotine plus antidepressants (RR = 1.30; 95%CI = 1.08-1.57; p = 0.006) and the number of sessions with pharmacists (RR = 1.21; 95%CI = 1.19-1.23; p < 0.001) were positively associated with cessation; a very high level of dependence was negatively associated (RR = 0.77; 95%CI = 0.67-0.89; p = 0.001). The smoking cessation services were effective and should be encouraged.
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Affiliation(s)
| | | | | | | | - Célio Rezende Lara-Júnior
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
- Belo Horizonte Municipality, Belo Horizonte 30130-003, Minas Gerais, Brazil
| | - Sabrina Gonçalves Ferreira
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Paula de Fátima Fernandes Blunk
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Adriano Max Moreira Reis
- Pharmaceutical Products Department, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Edna Afonso Reis
- Statistics Department, Exact Sciences Institute, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Djenane Ramalho-de-Oliveira
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Mariana Martins Gonzaga do Nascimento
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
- Pharmaceutical Products Department, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
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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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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: 4] [Impact Index Per Article: 2.0] [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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Kumar A, Ray AB, Blanchard C. Use of research evidence varied in efforts to expand specific pharmacist autonomous prescriptive authority: an evaluation and recommendations to increase research utilization. Health Res Policy Syst 2022; 20:1. [PMID: 34980147 PMCID: PMC8721476 DOI: 10.1186/s12961-021-00789-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An expanding body of literature shows that pharmacists' interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists' scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study investigated how stakeholders utilized research evidence when developing expanded scope of practice policies in their respective states. METHODS Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, semi-structured interviews with policy-makers and pharmacy advocates were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy-making process. Investigators analysed findings from the transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted. RESULTS Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policy-makers and researchers, and leveraging pharmacy practice stakeholders. CONCLUSIONS Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practise at the top of their license.
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Affiliation(s)
- Akshara Kumar
- Center for Medication Optimization, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, United States of America
| | - Amber Bivins Ray
- Center for Medication Optimization, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, United States of America
| | - Carrie Blanchard
- Center for Medication Optimization, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, United States of America
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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: 1] [Impact Index Per Article: 0.3] [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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Caryl FM, Pearce J, Reid G, Mitchell R, Shortt NK. Simulating the density reduction and equity impact of potential tobacco retail control policies. Tob Control 2021; 30:e138-e143. [PMID: 33148694 PMCID: PMC7612095 DOI: 10.1136/tobaccocontrol-2020-056002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Reducing the provision of tobacco is important for decreasing inequalities in smoking and smoking-related harm. Various policies have been proposed to achieve this, but their impacts-particularly on equity-are often unknown. Here, using national-level data, we simulate the impacts of potential policies designed to reduce tobacco outlet density (TOD). METHODS Tobacco retailer locations (n=9030) were geocoded from Scotland's national register, forming a baseline. Twelve policies were developed in three types: (1) regulating type of retailer selling tobacco, (2) regulating location of tobacco sales, and (3) area-based TOD caps. Density reduction was measured as mean percentage reduction in TOD across data zones and number of retailers nationally. Equity impact was measured using regression-based Relative Index of Inequality (RII) across income deprivation quintiles. RESULTS Policies restricting tobacco sales to a single outlet type ('Supermarket'; 'Liquor store'; 'Pharmacy') caused >80% TOD reduction and >90% reduction in the number of tobacco outlets nationally. However, RIIs indicated that two of these policies ('Liquor store', 'Pharmacy') increased socioeconomic inequalities in TOD. Equity-promoting policies included 'Minimum spacing' and exclusion zones around 'Child spaces'. The only policy to remove statistically significant TOD inequalities was the one deliberately targeted to do so ('Reduce clusters'). CONCLUSIONS Using spatial simulations, we show that all selected policies reduced provision of tobacco retailing to varying degrees. However, the most 'successful' at doing so also increased inequalities. Consequently, policy-makers should consider how the methods by which tobacco retail density is reduced, and success measured, align with policy aims.
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Affiliation(s)
- Fiona M Caryl
- MRC/CSO Social and Public Health Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, School of GeoSciences, The University of Edinburgh, Edinburgh, UK
| | | | - Richard Mitchell
- MRC/CSO Social and Public Health Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Niamh K Shortt
- Centre for Research on Environment, Society and Health, School of GeoSciences, The University of Edinburgh, Edinburgh, UK
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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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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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Screening, Brief Intervention, and Referral to Treatment in a Retail Pharmacy Setting: The Pharmacist's Role in Identifying and Addressing Risk of Substance Use Disorder. J Addict Med 2020; 13:403-407. [PMID: 30870202 DOI: 10.1097/adm.0000000000000525] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study determined the feasibility of interviewing and screening patients presenting to a retail pharmacy using Screening, Brief Intervention, and Referral to Treatment (SBIRT) interview protocols, and to compare SBIRT results to a risk score calculated from Prescription Drug Monitoring Program (PDMP) data. METHODS Using the NIDA Quick Screen and NIDA Modified-ASSIST (NM-ASSIST) and the Alcohol Use Disorder Identification Test (AUDIT), retail pharmacy customers were screened for substance and alcohol use disorder and tobacco use. PDMP reports were collected on subjects and a PDMP-risk score was calculated based on the numbers of Schedule II-V prescriptions and prescribers over the previous 12 months. RESULTS A total of 24 patients were included in this study (67% response rate). SBIRT screening revealed that 20.8% were at-risk for substance use disorder (SUD), 16.7% for alcohol use disorder, and 37.5% used tobacco. Overall, 33.3% of subjects were at-risk for SUD or alcohol use disorder. Fifty percent of subjects required education and/or brief intervention based on their responses, 37.5% of all subjects were deemed at-risk based on their PDMP-risk score, and 60% of patients who were risk-positive by SBIRT screening were also PDMP-risk positive. CONCLUSIONS This study demonstrates the feasibility of performing SBIRT-based screenings in a retail pharmacy setting and combining these with PDMP-risk analysis to screen patients for prescription and illicit drug misuse. Findings from this study will inform the design of larger multisite studies, which should validate these findings and include follow-up analysis to assess the efficacy of intervention on this patient population.
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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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15
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O'Reilly E, Frederick E, Palmer E. Models for pharmacist-delivered tobacco cessation services: a systematic review. J Am Pharm Assoc (2003) 2019; 59:742-752. [PMID: 31307963 DOI: 10.1016/j.japh.2019.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/08/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To summarize delivery models of pharmacist-led tobacco cessation services. DATA SOURCES Studies published from July 1, 2003, to April 1, 2019, describing pharmacist-led tobacco cessation services in the United States were identified via PubMed/MEDLINE and EBSCO searches. STUDY SELECTION Studies were considered for inclusion if they met the following criteria: population, patients 18 years of age and older using tobacco products; intervention, pharmacist-led tobacco cessation services; comparator, not required; and outcome, tobacco cessation. We used a web-based tool, Rayyan QCRI, to assist with study selection. DATA EXTRACTION We used a data extraction tool to collect article reference, study design, primary and secondary objectives, brief description of intervention, pharmacologic interventions, service model, business model, method to measure tobacco cessation, tobacco cessation rates, and other comments. RESULTS A total of 16 articles were incorporated into this review. Most studies included were observational (87.5%). The pharmacy settings included ambulatory care (68.8%), community (25%), and managed care (6.3%). Service models described most frequently followed an appointment-based, individual, face-to-face session between the patient and pharmacist. Business models included grant funding (12.5%), fee-for-service (6.3%), value-based (6.3%), and free services (6.3%), but most studies (56.3%) did not address reimbursement. Cessation rates ranged from 3.98% to 77.14% and were predominantly measured through self-report (62.5%). The timing of follow-up varied from 1 to 6 months after program completion, but in some articles was not reported (37.5%). CONCLUSION Pharmacists currently manage tobacco cessation services via an assortment of methods and can successfully assist patients in achieving abstinence. Gaps in the literature necessitate further guidance on consistent outcomes reporting, impact of service model on tobacco cessation, and economic data of business models. The profession will benefit from such information to further expand the pharmacists' role within tobacco cessation services.
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16
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Brown SJ. Pharmacy Technicians and Improving Onychomycosis Treatment Outcomes. J Pharm Technol 2019; 35:82-87. [PMID: 34860989 DOI: 10.1177/8755122518815057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To provide an overview of onychomycosis and current treatments and to identify opportunities for pharmacy technicians to improve treatment outcomes. Data Sources: A MEDLINE/PubMed search (1966 to October 2018) was performed using search terms designed to identify English-language articles on onychomycosis diagnosis, treatment, and prevention, as well as articles on the impact of pharmacy technicians on onychomycosis outcomes and the use of pharmacy technicians to improve treatment adherence. Study Selection and Data Extraction: Review articles and clinical studies describing onychomycosis, risk factors, treatment efficacy, and prevention of recurrent infections were included. Data Synthesis: Although no articles on the impact of pharmacy technicians in the treatment of onychomycosis were found, the importance of treatment adherence on positive outcomes highlights a potential role of pharmacy technicians. Pharmacy technicians can identify patients with potential onychomycosis based on questions about over-the-counter products and refer patients to the pharmacist for counseling on treatment. Pharmacy technicians can also reinforce treatment adherence at refill visits. Conclusions: Pharmacy technicians can have a positive impact on onychomycosis treatment outcomes by addressing barriers to successful treatment and promoting treatment adherence.
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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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18
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Bouchet-Benezech B, Champanet B, Rouzaud P. Smoking cessation at the pharmacy: feasibility and benefits based on a French observational study with six-month follow-up. Subst Abuse Rehabil 2018; 9:31-42. [PMID: 30046265 PMCID: PMC6054276 DOI: 10.2147/sar.s152186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In comparison to other European countries, the number of smokers remains high in France. Approximately five million smokers wish to quit within the year and need support that is local, easily accessible, and efficient. As public health actors, pharmacists could provide this service. The Sevrage Tabagique à l’Officine: Smoking Cessation Program at the Pharmacy (STOP) study was carried out to explore the feasibility of a smoking cessation program provided at pharmacies. Materials and methods Pharmacists participating in the study were trained to provide a smoking cessation program to smokers recruited at the pharmacy, which included five pharmaceutical interviews in six months, along with counseling and support, in addition to nicotine replacement therapy. This observational, longitudinal, prospective study assessed the feasibility of the program by measuring the percentage of participants remaining at the six-month visit, the proportion of invited pharmacies that actually participated in the program, and the benefits to the participants. Results Ninety pharmacies were invited to participate, 79 (88%) pharmacies entered the study, and 49 (54%) included study participants and treated 227 subjects with a mean age of 45.4 years. At six months, 23.3% of participants attended their follow-up visit, among which 75% had been abstinent since their last visit and more than half for 90 days. From the second follow-up visit, their Short Form 12 physical and mental health composite scores were improved in comparison with baseline. Participants and pharmacists all reported being highly satisfied with the program; however, the attrition rate was substantial, possibly due to some study limitations. Conclusion The provision of support for smoking cessation by pharmacies is feasible despite some barriers such as lack of awareness and difficulty to change habits for the smokers or lack of time and training for the pharmacists. The conditions necessary for this program to be implemented on a large scale include training of pharmacists, access to a private space in the pharmacy, remuneration for the pharmaceutical interviews, collaboration with other health care professionals, and an effective communications program regarding the service, both inside and outside of pharmacies. The relatively low number of participants at the end of the study could be improved by increasing awareness of the program, involving health authorities, and enlarging the number of pharmacies engaged in the program.
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Fahs IM, Hallit S, Rahal MK, Malaeb DN. The Community Pharmacist's Role in Reducing Cardiovascular Risk Factors in Lebanon: A Longitudinal Study. Med Princ Pract 2018; 27:508-514. [PMID: 29898452 PMCID: PMC6422117 DOI: 10.1159/000490853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the role of the pharmacist in modifying risk factors for cardiovascular disease (CVD) among Lebanese adults in urban and rural areas. METHODS In a prospective survey, 865 out of 1,000 participants aged ≥45 years, previously interviewed, agreed to be followed at 1 and 2 years time points. Parameters including blood pressure, lipid profile, blood glucose, average number of risk factors, and atherosclerotic CVD (ASCVD) risk were assessed and evaluated at the beginning of the study, then after 1 and 2 years. RESULTS During both follow-ups, the mean average body mass index and systolic blood pressure decreased significantly and the lipid profile improved significantly. Further significant improvements in ASCVD risk occurred during the second follow-up. Monitoring parameters revealed significant improvements as well. CONCLUSION This study showed that a plan that includes pharmacists, who regularly monitor and follow-up patients, could improve CVD prevention through the reduction of risk factors.
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Affiliation(s)
- Iqbal M Fahs
- School of Pharmacy, Lebanese International University, Mouseitbah, Lebanon
| | - Souheil Hallit
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut,
- Lebanese University, Faculty of Pharmacy, Beirut,
- Holy Spirit University of Kaslik, Faculty of Medicine and Medical Sciences, Kaslik,
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib,
- Occupational Health Environment Research Team, U1219 BPH Bordeaux Population Health Research Center Inserm, Université de Bordeaux, Bordeaux,
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Faculty of Public Health, Lebanese University, Beirut,
| | - Mohamad K Rahal
- School of Pharmacy, Lebanese International University, Mouseitbah, Lebanon
| | - Diana N Malaeb
- School of Pharmacy, Lebanese International University, Mouseitbah, Lebanon
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20
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Myers Virtue S, Rotz ME, Boyd M, Lykon JL, Waldron EM, Theodorou J. Impact of a novel interprofessional dental and pharmacy student tobacco cessation education programme on dental patient outcomes. J Interprof Care 2017; 32:52-62. [DOI: 10.1080/13561820.2017.1378171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Shannon Myers Virtue
- Department of Pediatric Dentistry and Community Oral Health Sciences, Temple University Kornberg School of Dentistry, Philadelphia, PA, USA
- Christiana Care Health System, Helen F. Graham Cancer Center & Research Institute, Newark, DE, USA
| | - Melissa E Rotz
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA
| | - Matthew Boyd
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA
| | - Jillian L Lykon
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA
| | - Elizabeth M Waldron
- Department of Pediatric Dentistry and Community Oral Health Sciences, Temple University Kornberg School of Dentistry, Philadelphia, PA, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jacqueline Theodorou
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA
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Greenhalgh T, Macfarlane F, Steed L, Walton R. What works for whom in pharmacist-led smoking cessation support: realist review. BMC Med 2016; 14:209. [PMID: 27978837 PMCID: PMC5159995 DOI: 10.1186/s12916-016-0749-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New models of primary care are needed to address funding and staffing pressures. We addressed the research question "what works for whom in what circumstances in relation to the role of community pharmacies in providing lifestyle interventions to support smoking cessation?" METHODS This is a realist review conducted according to RAMESES standards. We began with a sample of 103 papers included in a quantitative review of community pharmacy intervention trials identified through systematic searching of seven databases. We supplemented this with additional papers: studies that had been excluded from the quantitative review but which provided rigorous and relevant additional data for realist theorising; citation chaining (pursuing reference lists and Google Scholar forward tracking of key papers); the 'search similar citations' function on PubMed. After mapping what research questions had been addressed by these studies and how, we undertook a realist analysis to identify and refine candidate theories about context-mechanism-outcome configurations. RESULTS Our final sample consisted of 66 papers describing 74 studies (12 systematic reviews, 6 narrative reviews, 18 RCTs, 1 process detail of a RCT, 1 cost-effectiveness study, 12 evaluations of training, 10 surveys, 8 qualitative studies, 2 case studies, 2 business models, 1 development of complex intervention). Most studies had been undertaken in the field of pharmacy practice (pharmacists studying what pharmacists do) and demonstrated the success of pharmacist training in improving confidence, knowledge and (in many but not all studies) patient outcomes. Whilst a few empirical studies had applied psychological theories to account for behaviour change in pharmacists or people attempting to quit, we found no studies that had either developed or tested specific theoretical models to explore how pharmacists' behaviour may be affected by organisational context. Because of the nature of the empirical data, only a provisional realist analysis was possible, consisting of five mechanisms (pharmacist identity, pharmacist capability, pharmacist motivation and clinician confidence and public trust). We offer hypotheses about how these mechanisms might play out differently in different contexts to account for the success, failure or partial success of pharmacy-based smoking cessation efforts. CONCLUSION Smoking cessation support from community pharmacists and their staff has been extensively studied, but few policy-relevant conclusions are possible. We recommend that further research should avoid duplicating existing literature on individual behaviour change; seek to study the organisational and system context and how this may shape, enable and constrain pharmacists' extended role; and develop and test theory.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Fraser Macfarlane
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The LondonSchool of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liz Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The LondonSchool of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert Walton
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The LondonSchool of Medicine and Dentistry, Queen Mary University of London, London, UK
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van der Molen T, van Boven JFM, Maguire T, Goyal P, Altman P. Optimizing identification and management of COPD patients - reviewing the role of the community pharmacist. Br J Clin Pharmacol 2016; 83:192-201. [PMID: 27510273 PMCID: PMC5225927 DOI: 10.1111/bcp.13087] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/08/2016] [Accepted: 08/01/2016] [Indexed: 01/03/2023] Open
Abstract
The aim of this paper was to propose key steps for community pharmacist integration into a patient care pathway for chronic obstructive pulmonary disease (COPD) management. A literature search was conducted to identify publications focusing on the role of the community pharmacist in identification and management of COPD. The literature search highlighted evidence supporting an important role for pharmacists at each of the four key steps in the patient care pathway for COPD management. Step 1 (primary prevention): pharmacists are ideally placed to provide information on disease awareness and risk prevention campaigns, and to encourage lifestyle interventions, including smoking cessation. Step 2 (early detection/case finding): pharmacists are often the first point of contact between the patient and the healthcare system and can therefore play an important role in the early identification of patients with COPD. Step 3 (management and ongoing support): pharmacists can assist patients by providing advice and education on dosage, inhaler technique, treatment expectations and the importance of adherence, and by supporting self‐management, including recognition and treatment of COPD exacerbations. Step 4 (review and follow‐up): pharmacists can play an important role in monitoring adherence and ongoing inhaler technique in patients with COPD. In summary, pharmacists are ideally positioned to play a vital role in all key stages of an integrated COPD patient care pathway from early disease detection to the support of management plans, including advice and counselling regarding medications, inhaler technique and treatment adherence. Areas requiring additional consideration include pharmacist training, increasing awareness of the pharmacist role, administration and reimbursement, and increasing physician–pharmacist collaboration.
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Affiliation(s)
- Thys van der Molen
- Department of Primary Care, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Department of Pharmacy, Unit of PharmacoEpidemiology and PharmacoEconomics, University of Groningen, Groningen, The Netherlands
| | - Terence Maguire
- Community Pharmacist and School of Pharmacy, Queen's University, Belfast, UK
| | | | - Pablo Altman
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Mdege ND, Chevo T, Toner P. Perceptions of current and potential public health involvement of pharmacists in developing nations: The case of Zimbabwe. Res Social Adm Pharm 2016; 12:876-884. [PMID: 26703215 DOI: 10.1016/j.sapharm.2015.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is increasing recognition of the potential significant contribution that pharmacy personnel can make to improve the public's health. However, there is an evidence gap in developing countries on the public health role of pharmacy personnel. OBJECTIVES This study aimed to explore the current public health activities that pharmacy professionals in Zimbabwe are currently involved in, and the potential of expanding this role. METHODS The study utilized individual, face-to-face, semi-structured qualitative interviews with 9 key informants. The sample reflected the diversity of pharmacy practice groups and levels as well as professional experience, and included a representative from a patient group, and a non-pharmacist national level public health expert. Data collection and analysis was an iterative process informed both by the currently available literature on the topic, as well as themes emerging from the data. Framework analysis was utilized with two independent analyses performed. KEY FINDINGS There was a general consensus among participants that pharmacy practice in Zimbabwe was mainly focused on curative services, with very limited involvement in public health oriented activities. The following were identified as pharmacists' current public health activities: supply chain management of pharmaceutical products, provision of medications and other pharmaceutical products to patients, therapy monitoring, identification and monitoring of chronic illnesses, information provision and training of pharmacists. Nevertheless, there were concerns regarding the quality of some of these services, and lack of consistency in provision across pharmacies. Other potential areas for pharmacists' public health practice were identified as emergency response, drug abuse, addressing social determinants of health particularly promoting healthy lifestyles, applied health research, counterfeit and substandard medicines, and advocacy. CONCLUSIONS There is perceived potential for Zimbabwean pharmacists to become more involved in public health oriented services. However, concerns regarding the quality of services and lack of consistency in provision need to be addressed.
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Affiliation(s)
- Noreen Dadirai Mdege
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK.
| | - Tafadzwa Chevo
- Department of Sociology, University of Zimbabwe, Harare, Zimbabwe
| | - Paul Toner
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
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Schultz ASH, Guzman R, Sawatzky JAV, Thurmeier R, Fedorowicz A, Fulmore K. Reframing tobacco dependency management in acute care: A case study. Health Policy 2016; 120:967-74. [PMID: 27392584 DOI: 10.1016/j.healthpol.2016.06.009] [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: 10/25/2015] [Revised: 04/17/2016] [Accepted: 06/14/2016] [Indexed: 11/28/2022]
Abstract
Effective tobacco dependence treatment within acute care tends to be inadequate. The purpose of the Utilizing best practices to Manage Acute care patients Tobacco Dependency (UMAT) was to implement and evaluate an evidence-based intervention to support healthcare staff to effectively manage nicotine withdrawal symptoms of acute surgical patients. Data collection for this one-year longitudinal case study included: relevant patient experiences and staff reported practice, medication usage, and chart review. Over the year each data source suggested changes in tobacco dependence treatment. Key changes in patient survey responses (N=55) included a decrease in daily smoking and cigarette cravings. Of patients who used nicotine replacement therapy, they reported an increase in symptom relief. Staff (N=45) were surveyed at baseline, mid-point and end of study. Reported rates of assessing smoking status did not change over the year, but assessment of withdrawal symptoms emerged as daily practice and questions about cessation diminished. Also delivery of nicotine replacement therapy products increased over the year. Chart reviews showed a shift in content from documenting smoking behavior to withdrawal symptoms and administration of nicotine replacements; also frequency of comments increased. In summary, the evidence-based intervention influenced unit norms and reframed the culture related to tobacco dependence treatment.
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Affiliation(s)
- Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 369 Tache Avenue, CR 3022 Asper Clinical Research Institute, Winnipeg, MB R2H 2A6, Canada.
| | - Randolph Guzman
- St-Boniface General Hospital and Surgery Department Max Rady College of Medicine, Rady Faulty of Health Sciences, University of Manitoba, 351Tache Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Jo-Ann V Sawatzky
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3 T 2N2, Canada
| | - Rick Thurmeier
- St-Boniface General Hospital 351 Tache Avenue, Winnipeg, MB R2H 2A6 Canada
| | - Anna Fedorowicz
- St-Boniface General Hospital 351 Tache Avenue, Winnipeg, MB R2H 2A6 Canada
| | - Kaitlin Fulmore
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 369 Tache Avenue, CR 3022 Asper Clinical Research Institute, Winnipeg, MB R2H 2A6, Canada
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Sohanpal R, Rivas C, Steed L, MacNeill V, Kuan V, Edwards E, Griffiths C, Eldridge S, Taylor S, Walton R. Understanding recruitment and retention in the NHS community pharmacy stop smoking service: perceptions of smoking cessation advisers. BMJ Open 2016; 6:e010921. [PMID: 27388355 PMCID: PMC4947750 DOI: 10.1136/bmjopen-2015-010921] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To understand views of pharmacy advisers about smoker recruitment and retention in the National Health Service community pharmacy stop smoking programme. DESIGN Thematic framework analysis of semistructured, in-depth interviews applying the Theoretical Domains Framework and COM-B behaviour change model. We aimed to identify aspects of adviser behaviour that might be modified to increase numbers joining and completing the programme. PARTICIPANTS 25 stop smoking advisers (13 pharmacists and 12 support staff). SETTING 29 community pharmacies in 3 inner east London boroughs. RESULTS Advisers had preconceived ideas about smokers likely to join or drop out and made judgements about smokers' readiness to quit. Actively recruiting smokers was accorded low priority due in part to perceived insufficient remuneration to the pharmacy and anticipated challenging interactions with smokers. Suggestions to improve smoker recruitment and retention included developing a more holistic and supportive approach using patient-centred communication. Training counter assistants were seen to be important as was flexibility to extend the programme duration to fit better with smokers' needs. CONCLUSIONS Cessation advisers feel they lack the interpersonal skills necessary to engage well with smokers and help them to quit. Addressing advisers' behaviours about active engagement and follow-up of clients, together with regular skills training including staff not formally trained as cessation advisers, could potentially boost numbers recruited and retained in the stop smoking programme. Adjustments to the pharmacy remuneration structure to incentivise recruitment and to allow personalisation of the programme for individual smokers should also be considered.
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Affiliation(s)
- Ratna Sohanpal
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Liz Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Valerie Kuan
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elizabeth Edwards
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris Griffiths
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie Taylor
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert Walton
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Smoking quit rates among patients receiving pharmacist-provided pharmacotherapy and telephonic smoking cessation counseling. J Am Pharm Assoc (2003) 2016; 56:129-36. [DOI: 10.1016/j.japh.2016.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 11/15/2022]
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Rhodiola rosea L. extract and its active compound salidroside antagonized both induction and reinstatement of nicotine place preference in mice. Psychopharmacology (Berl) 2014; 231:2077-86. [PMID: 24264566 DOI: 10.1007/s00213-013-3351-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/28/2013] [Indexed: 12/26/2022]
Abstract
RATIONALE Conventional pharmacological treatments for drug addiction aim to reduce three most important aspects: withdrawal syndrome, craving, and relapse. Pharmacological treatments currently available for the treatment of tobacco smoking are able to alleviate withdrawal symptoms but are not sufficiently effective in reducing craving and rarely effective to prevent relapse. Rhodiola rosea L., a well-known traditional oriental medicine with anxiolytic, antidepressive, antistress, and adaptogenic properties, has been recently shown to be effective in the prevention and treatment of nicotine-withdrawal symptoms. OBJECTIVES The present study used the conditioned place preference (CPP) model to systematically investigate, in mice, the effects of a R. rosea L. extract (RHO) and its active compound salidroside (SDS), on the reinforcing properties of nicotine and their efficacy in the vulnerability to reinstatement. METHODS To study the effects on the rewarding properties of nicotine, RHO (10, 15, and 20 mg/kg) and SDS (0.2 mg/kg) were tested both in the acquisition and expression of CPP induced by nicotine injection (0.5 mg/kg). Moreover, the efficacy of RHO and SDS in preventing relapse induced by nicotine priming (0.1 mg/kg, s.c.) and by restraint stress was also evaluated. RESULTS Results showed the ability of RHO and salidroside to significantly reduce the rewarding properties of nicotine at all doses tested. RHO and SDS also suppressed both priming- and stress-induced reinstatement of CPP. CONCLUSIONS The present study showed the positive effects of R. rosea L. in reducing rewarding properties and preventing relapse to nicotine and evidenced the important role of salidroside in the effects of the extract.
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Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences. Int J Clin Pharm 2013; 35:1178-87. [PMID: 24013957 DOI: 10.1007/s11096-013-9845-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies indicate that community pharmacy-based alcohol brief intervention (BI) is feasible. However, few studies report significant reductions in post-BI alcohol consumption and customer experience. Cost-effectiveness has not been previously examined. OBJECTIVES This 5 month study adopted a single group pre- and post-experimental design to: (1) assess uptake of the community pharmacy alcohol BI service; (2) establish post-BI changes in alcohol consumption for hazardous drinkers; (3) report the acceptability of the service to customers who received it; and (4) undertake a preliminary economic evaluation of the service through establishing whether pharmacy-based alcohol BI affected health and social care costs, including lost employment costs, and whether it was cost-effective. SETTING 26 community pharmacies in south London, UK. METHOD Trained pharmacists used the AUDIT-C and a retrospective 7-day Drinking Diary to identify risky drinkers and inform feedback and advice. Harmful drinkers were referred to their general practitioner and/or specialist alcohol services. A confidential service feedback questionnaire was completed by alcohol BI recipients. Baseline and 3-month follow-up telephone interviews were conducted with hazardous and low risk drinkers to assess post-BI alcohol use change and service cost-effectiveness. MAIN OUTCOME MEASURES AUDIT-C, 7-day alcohol unit consumption, drinking days, cost utilisation data. RESULTS Of the 663 eligible customers offered alcohol BI, 141 (21 %) took up the service. Three-quarters of customers were identified as risky drinkers. Follow-up interviews were conducted with 61 hazardous/low risk drinkers (response rate = 58 %). Hazardous drinkers were found to significantly reduce their 7-day alcohol unit consumption and drinking days, but not AUDIT-C scores. The majority of harmful drinkers (91 %, n = 10) who were contactable post-BI had accessed further alcohol related services. Customer feedback was generally positive. Over 75 % of customers would recommend the service to others. The cost of delivering the service was estimated to be £ 134. The difference in service costs pre-BI and post-BI was not statistically significant and remained non-significant when calculated on 500 customers receiving the intervention. CONCLUSION Community pharmacy-based alcohol BI is a low cost service that may not have immediate beneficial impact on health and social service use, but can be effective in reducing drinking in hazardous drinkers.
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