Smoking Cessation: Part 1-An Overview

Development and implementation of a smoking cessation clinic in community pharmacy practice

OBJECTIVE

To describe a pharmacist-operated program to help people stop smoking.

SETTING

Community chain (mass-merchandise) pharmacy practice sites in Virginia.

PARTICIPANTS

Faculty at the Virginia Commonwealth University School of Pharmacy (VCU) and 15 practicing pharmacists.

PRACTICE DESCRIPTION

Smoking cessation clinics within the pharmacy departments of seven Target stores.

PRACTICE INNOVATION

With input from the practicing pharmacists and using the most current strategies reported in the literature, faculty at VCU developed a training manual for smoking cessation counseling. This manual was used to facilitate a 4-hour training session and also served as a resource for pharmacists in the smoking cessation clinics. Pharmacists were taught about behavioral modifications, the Transtheoretical Model of Change as applied to smoking cessation, documentation, the Fagerström Test for Nicotine Dependence, smoking cessation therapies, patient counseling techniques, physical assessment skills, and how to develop an individualized action plan for smoking cessation. As pharmacists established smoking cessation clinics, issues such as workflow, continuous quality improvement, and marketing were addressed by the faculty members and practitioners.

RESULTS

Using the process and tools described in this article, pharmacists successfully established and operated smoking cessation clinics.

CONCLUSION

The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.

Smoking cessation: Part 2--Pharmacologic approaches

OBJECTIVE

To present the concept of nicotine-replacement therapy (NRT) and the pharmacologic approaches, nonprescription and prescription, to smoking cessation.

DATA SOURCES

Current clinical literature.

DATA SYNTHESIS

NRT can be delivered through a number of different nicotine-containing dosage forms (e.g., gum, patch, nasal spray, oral inhaler). The Agency for Health Care Policy and Research (AHCPR) recommends using the nicotine patches for routine clinical practice and the American Psychiatric Association (APA) recommends the use of the patches and gum as initial pharmacotherapies for smoking cessation. There are no comparative studies indicating the superiority of one form or another at relieving nicotine withdrawal symptoms. Of the other pharmacologic agents used for smoking cessation, bupropion hydrochloride demonstrates the most promise.

CONCLUSION

The pharmacist can assist the consumer with the selection of an OTC smoking cessation product and serve as an informational resource to consumers and physicians desiring information on prescription drug products for smoking cessation.