A randomized controlled trial of a smoking cessation intervention based in community pharmacies

Community pharmacists' perceptions on their role in counseling patients on lifestyle modifications

BACKGROUND

Patients need an accessible health care provider who can assist in lifestyle counseling for chronic disease states. Pharmacists are easily accessible in the community, as a recent study found that nearly 90% of Americans live within 5 miles of a community pharmacy. Thus, pharmacists are ideally positioned to offer counseling on lifestyle modifications at this health care access point.

OBJECTIVES

The study's primary objective was to identify common barriers that community pharmacists may face in regard to provision of lifestyle counseling. Secondary objectives included determining strategies to overcome barriers and examining community pharmacists' willingness and level of comfort in providing lifestyle counseling to their patients.

METHODS

The study used mixed methods where pharmacists completed a survey and opted into a semi-structured interview. Survey results were analyzed with descriptive statistics and a paired t test. Interviews were recorded and transcribed in April and May 2022 until saturation. Three investigators coded each interview and conducted thematic analysis. Study design and procedures were approved by an institutional review board in December 2021.

RESULTS

One hundred forty-one pharmacists completed the survey to yield a 53.2% response rate. A paired t test revealed a statistically significant difference between level of comfort and willingness to counsel (P < 0.001). Willingness to provide lifestyle counseling was higher than the level of comfort in counseling in all areas (alcohol moderation, exercise, nutrition, tobacco cessation, and weight loss). Thematic analysis of the semi-structured interviews revealed 5 dominant themes: increasing patient awareness, counseling due to a patient inquiry, increasing educational materials, aligning corporate measures, and counseling patients with an established relationship.

CONCLUSION

Community pharmacists are willing to counsel on lifestyle modifications, however there is a gap between their willingness and comfort in counseling. The top 3 barriers to community pharmacists counseling on lifestyle modifications included time, workflow, and patient willingness. Further studies should explore strategies for implementing lifestyle counseling.

Assessment of community pharmacy professionals' willingness, involvement, beliefs, and barriers to offer health promotion services: a cross-sectional study

INTRODUCTION

The role of community pharmacy professionals has been expanded to patient care and health promotion service globally. However, in Ethiopia, there is a scanty of data on the issue, although the country is dealing with a double burden of non-communicable and communicable diseases.

OBJECTIVES

This study aimed to assess community pharmacy professionals' willingness, involvement, beliefs, and barriers to offer extended services for health promotion in Injibara town, Amhara, Ethiopia.

METHODS

A cross-sectional study was conducted among licensed and registered community pharmacy professionals working in Injibara town from June 25 to July 10, 2022. A structured self-administered questionnaire was used to collect data. The data were presented using descriptive statistics. The data were analyzed using STATA version 16 software.

RESULTS

A total of 24 community pharmacy professionals were involved in the study, with a response rate of 92.3%. Approximately 91.7% of them were involved in health promotional services. Of them, 54.1% were willing and strongly believed that their involvement in health promotion services would have a positive impact on promoting health. A total of 60.9% of the community pharmacy professionals reported that they were very involved in family planning and alcohol consumption counseling. Different barriers to not providing health promotion services were also cited.

CONCLUSIONS

Majority of community pharmacy professionals in this study is involved in health promotional services but there are also barriers on their involvement. Therefore, governmental strategies to overcome the barriers that hamper their involvement should be designed.

Effectiveness and cost-effectiveness of an intensive and abbreviated individualized smoking cessation program delivered by pharmacists: A pragmatic, mixed-method, randomized trial

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.

A Pragmatic Pilot Cluster-Randomized Study of Tobacco Screening and Smoking Cessation Program for Community Pharmacies in Japan: FINE Program

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.

Smoking Cessation Services by Community Pharmacists: Real-World Practice in Thailand

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.

Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure

BACKGROUND

Pharmacists' roles and services for patients with substance use are not well defined and inconsistent from site to site. Several barriers have been identified that hinder pharmacists' care for people who use substances, such as a lack of training and resources. Clinical practice tools can aid in transferring evidence-based approaches to the practice sphere.

OBJECTIVES

The aim of the study was to develop a substance misuse management toolkit for community pharmacists to help them manage their encounters with people who use substances.

METHODS

A focused literature review was conducted and 2 needs assessment studies, one for community pharmacists and one for patients informed the development of the toolkit. The toolkit is an adaption of the screening, brief intervention, and referral to treatment (SBIRT) approach, which is one of the most well-defined and effective strategies for substance use management. However, SBIRT is a novel care model in community pharmacy settings. Therefore, a substance misuse management toolkit with 20 items was created for community pharmacists incorporating evidence-based strategies and clinical algorithms. Delphi procedure was used to validate the toolkit.

RESULTS

Two rounds of questions were sent to experts in the field of substance misuse, some of whom were pharmacists. In both rounds, these experts were asked to rate the appropriateness and clarity of items in the toolkit and provide comments and suggestions. Items with a median rating of 7 or more out of 10 were included in the toolkit. In the second round, the experts were asked to rerate the revised version and provide additional feedback. After the second round, agreement was reached for almost all items of the toolkit.

CONCLUSION

A Delphi procedure was successfully used to provide evidence of the validity of the new guiding toolkit for community pharmacists. The toolkit will be implemented and evaluated to provide additional evidence of validity in practice.

Smoking Cessation at the Community Pharmacy: Determinants of Success from a Real-Life Practice

The objectives of this study are to report the contribution of pharmacists to smoking cessation and study the determinants of smoking cessation success in eight pharmacies in Portugal (south) between 2009 and 2019. A real-life study was conducted with a sample of smokers who participated in pharmacist consultations. The sample included 135 smokers (average age of 47.9 ± 1.21 years), 79 (58.5%) of whom were male. In parallel with the motivation and behavioral approach, 116 (85.9%) smokers received pharmacological therapies: 108 (80.0%) were treated with nicotine replacement products and eight (5.9%) with non-nicotine medications. The interventions resulted in 70 (51.9%) smokers complying with the quit day, of whom 59 (43.7%) were smoking-abstinent at the end of the first month. Success rates were reduced to 32.6%, 28.1%, and 20.7% at the end of the 3rd, 6th, and 12th months, respectively. Smoking cessation was more successful for the participants receiving pharmacological therapies (Fisher’s exact test, p < 0.001) and those who participated in more pharmacist consultations (χ² = 59.994, p < 0.001) and more telephone sessions (χ² = 17.845, p < 0.001). Pharmacists can contribute significantly to the promotion of smoking cessation. Smokers who are more thoroughly followed up by pharmacists showed increased success rates when compared with smokers having fewer sessions with pharmacists.

Exploring the quality of smoking cessation in community pharmacies: A simulated patient study

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.

A cross sectional study on beliefs and roles of community pharmacy professionals in preventing and managing metabolic syndrome in an Ethiopian setting

INTRODUCTION

Metabolic syndrome (MetS) is a group of cardiovascular risk factors, and its prevalence is becoming alarmingly high in Ethiopia. Studies uncovered as community pharmacy professionals (CPPs) have not yet well integrated into public health programs and priorities. In low income setting like Ethiopia, evidence regarding the roles CPPs in preventing and management of MetS is dearth.

OBJECTIVE

The study was aimed to assess community pharmacy professionals'(CPPs) opinions about metabolic syndrome, describe their perception level towards the effectiveness of the main interventions and explore their extent of involvement in counseling patients with the metabolic syndrome in Gondar town, Northwestern Ethiopia.

METHOD

A descriptive, cross-sectional study was conducted among pharmacists and druggists working in community medication retail outlets (CMROs) in Gondar town, northwestern Ethiopia from April 1 to May 31, 2019. Data were collected using a self-administered pre-tested questionnaire. Descriptive statistics was used to summarize different variables, and presented in tables and figure. An independent t-test and one way ANOVA (Analysis of Variance) were used to compare mean scores. A 5% level of significance was used.

RESULT

Out of the 75 CPPs approached, 65(40 pharmacists and 25 druggists) completed the survey giving a response rate of 86.7%. Smoking cessation practice was identified to be low. There were a statistically significant difference (t = 2.144, P = 0.036) in the involvement towards counseling patients between CPPs who claimed to work in pharmacy (mean = 3.96 out of 5 points Likert scale) and drug stores (mean = 3.80 out of 5 points Likert scale).

CONCLUSION

The study concluded that the overall involvement of professionals in counseling patients, opinion about metabolic syndrome, and perception towards the effectiveness of the intervention was found to be more or less positive. However, the provision of services, such as monitoring therapy, selling equipment for home blood pressure and glucose monitoring and documenting patient care services needs to be encouraged. Given proper education and training, the current study hope that community pharmacists could be an important front-line contributors to contain this emerging epidemic in Gondar town as well as in the entire nation.

Pharmacists' roles in supporting people living with severe and persistent mental illness: a systematic review protocol

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.

A Comparative Study of the Cost and Uptake of Community Pharmacy "Stop Smoking and Emergency Contraception" Services from the Perspective of the National Health Service

OBJECTIVE

The objective was to explore if the community pharmacy (CP) stop smoking service (SSS) and emergency hormonal contraception patient group direction (EHC PGD) meet the needs of the English population and are cost-effective.

METHODS

This research was completed over 2 years. Public health resources provided details of CPs and provision of SSS and EHC PGD. Questionnaires were sent to smoking cessation/sexual health leads in local authorities to obtain information not available elsewhere. Questionnaires inquired about CP payment for provision of SSS and EHC PGD, overhead costs, successful outcomes, and validation methods. Quit rates at 4-weeks, 52-weeks, and lifetime determined SSS effectiveness. The effectiveness of EHC PGD was based on the probability of unintended pregnancy with/without levonorgestrel. Incremental cost-effectiveness ratio and cost of quality-adjusted life years (QALYs) gained were calculated. Descriptive statistics were determined. A priori of less than 0.05 (P < 0.05) was significant.

FINDINGS

SSS provision and uptake did not match local needs (smoking prevalence) even though increased CP SSS provision correlated with increased SSS success. Similarly, the need (based on teenage pregnancy rates) for EHC PGD did not correlate with the rate of CP provision but only with the uptake. Nevertheless, the provision of SSS and EHC PGD from CPs was cost-effective from an NHS perspective. Various assumptions were tested, but in all cases fell well below NICE QALY recommendations for cost-effectiveness.

CONCLUSION

Provision of SSS and EHC PGD from CP does not meet the needs of the population even though the delivery of these services is cost-effective.

Knowledge of heart attack and stroke symptoms among US Native American Adults: a cross-sectional population-based study analyzing a multi-year BRFSS database

Background

Heart disease and stroke are among the leading causes of death in Native Americans. Knowledge of heart attack and stroke symptomology are essential for prompt identification of symptoms and for appropriate action in seeking care. Knowledge of heart attack and stroke symptoms among US Native American adults was this study’s focus.

Methods

Multivariate techniques were used to analyze national surveillance data. Native American adults comprised the study population. Low heart attack and stroke knowledge score was the dependent variable.

Results

Logistic regression analysis yielded that Native American adults with low heart attack and stroke composite knowledge scores were more likely to be: older, less educated, poorer, uninsured, a rural resident, male, without a primary health care provider, and lacking a recent medical checkup.

Conclusions

The identified characteristics of Native American adults with heart attack and stroke knowledge deficits or disparities should guide educational initiatives by health care providers focusing on improving such knowledge.

Consumer perceptions of community pharmacy-based promotion of mental health and well-being

ISSUE ADDRESSED

With nearly half of all Australians likely to experience a mental illness, increasing community-based mental health promotion is warranted. Community pharmacies are accessible health care destinations that effectively provide a range of public health services. This study explored consumer opinions of mental health promotion in the community pharmacy setting, the activities they have observed and the perceived role/s of pharmacy staff in this area.

METHODS

A survey was informed by five interviews with pharmacy consumers and a literature review. Adult pharmacy consumers were recruited nationwide via a Research Panel company between December 2018 and January 2019. Survey data were descriptively analysed and associations confirmed by chi-square analysis.

RESULTS

Data were analysed from 537 of the 577 respondents; 34.3% of participants had a lived experience of mental illness. Just under a quarter of participants (23.3%) had observed mental health promotion in community pharmacy. Pharmacy was viewed as a suitable environment for this promotion by most respondents (n = 446/516), particularly those with lived experience, with a preference for in-store leaflets, posters and linking with existing national mental health organisations/campaigns. Lack of privacy and the busy pharmacy environment were identified as barriers for promotion in this setting.

CONCLUSION

There is a clear potential for mental health promotion within community pharmacies, although the uptake and impact of such activities require further investigation. SO WHAT?: These findings highlight a missed opportunity for pharmacists to engage with consumers about mental health and well-being, even though community pharmacies are accessible health care destinations.

Pharmacist-Delivered Smoking Cessation Program in Community Pharmacy (The FINE Program) in Japan-The Development of a Training Course and a Feasibility Study

AIM

Although smoking cessation support has been recommended as a routine component of pharmacists'duties, there is limited evidence of smoking cessation being achieved successfully in community pharmacy. The aim of this study was to develop a new smoking cessation program for use in the community pharmacy setting and investigate its feasibility.

METHODS

A feasibility study (the Family pharmacist's Intervention for Nicotine Elimination [FINE] program) was conducted using 8 pharmacists at 2 community pharmacies in Japan. The pharmacists recruited as subjects smokers 20 or more years of age who were taking medications such as antidiabetes drugs. The patients completed questionnaires assessing their smoking status, and the pharmacists provided them with smoking cessation support services. Participating patients met with the pharmacists or talked to them on the phone 5 times at 2- to 4-week intervals and received personalized and structured brief smoking cessation advice. The primary outcome was continuous abstinence determined by Micro Smokerlyzer carbon monoxide monitor at 3 months.

RESULTS

Of 5306 patients, 2296 patients were screened and the rate of smoking was found to be 12.7%. Five smoking patients received the FINE program from pharmacists who had received training. One of the 5 succeeded in quitting smoking after 3 months.

CONCLUSIONS

This is the first study to target Japanese smoking patients in community pharmacies with a brief structured intervention. The results tentatively support the feasibility of the FINE program. Further research including a randomized controlled trial is required to confirm the effectiveness of the FINE program.

Community pharmacy interventions for health promotion: effects on professional practice and health outcomes

BACKGROUND

Community pharmacies are an easily accessible and cost-effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health-promoting behaviours that aim to improve health and to optimise the management of long-term conditions. However, it remains uncertain whether these health-promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities.

OBJECTIVES

To assess the effectiveness and safety of health-promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies.

SEARCH METHODS

We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies.

SELECTION CRITERIA

We included randomised trials of health-promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health-related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only.

DATA COLLECTION AND ANALYSIS

We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health-related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations.

MAIN RESULTS

We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty-nine studies were conducted in high-income countries, and eight in middle-income countries. We found no studies that had been conducted in low-income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination - mainly in individually randomised studies - and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias. Professional practice outcomes We conducted a narrative analysis for pharmacy worker behaviour due to high heterogeneity in the results. Health-promotion interventions probably improve pharmacy workers' behaviour (2944 participants; 9 studies; moderate-certainty evidence) when compared to no intervention. These studies typically assessed behaviour using a simulated patient (mystery shopper) methodology. Pharmacy user outcomes Health-promotion interventions probably lead to a slight improvement in health-related behaviours of pharmacy users when compared to usual treatment (SMD 0.43, 95% CI 0.14 to 0.72; I² = 89%; 10 trials; 2138 participants; moderate-certainty evidence). These interventions probably also lead to a slight improvement in intermediate clinical outcomes, such as levels of cholesterol or glycated haemoglobin, for pharmacy users (SMD -0.43, 95% CI -0.65 to -0.21; I² = 90%; 20 trials; 3971 participants; moderate-certainty evidence). We identified no studies that evaluated the impact of health-promotion interventions on event-based clinical outcomes, such as stroke or myocardial infarction, or the psychological well-being of pharmacy users. Health-promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (SMD 0.29, 95% CI 0.08 to 0.50; I²= 82%; 10 trials, 2687 participants; moderate-certainty evidence). Adverse events No studies reported adverse events for either pharmacy workers or pharmacy users. Costs We found that health-promotion interventions are likely to be cost-effective, based on moderate-certainty evidence from five of seven studies that reported an economic evaluation.

AUTHORS' CONCLUSIONS

Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change.

How To Support Smoking Cessation In Primary Care And The Community: A Systematic Review Of Interventions For The Prevention Of Cardiovascular Diseases

Introduction

Smoking is a major risk factor for cardiovascular diseases (CVDs) and for many types of cancers. Despite recent policies, 1.1 billion people are active smokers and tobacco is the leading cause of mortality and illness throughout the world. The aim of this work was to identify smoking cessation interventions which could be implemented in primary care and/or at a community level.

Methods

A systematic review of CVDs prevention guidelines was realized using the ADAPTE Process. These were identified on G-I-N and TRIP databases. Additionally, a purposive search for national guidelines was successfully undertaken. Guidelines focusing on non-pharmacological lifestyle interventions, published or updated after 2011, were included. Exclusion criteria were specific populations, management of acute disease and exclusive focus on pharmacological or surgical interventions. After appraisal with the AGREE II tool, high-quality guidelines were included for analysis. High-grade recommendations and the supporting bibliographic references were extracted. References had to be checked in detail where sufficient information was not available in the guidelines.

Results

Nine hundred and ten guidelines were identified, 47 evaluated with AGREE II and 26 included. Guidelines recommended that patients quit smoking and that health care professionals provided advice to smokers but failed to propose precise implementation strategies for such recommendations. Only two guidelines provided specific recommendations. In the guideline bibliographic references, brief advice (BA) and multiple session strategies were identified as effective interventions. These interventions used Prochaska theory, motivational interviewing or cognitive-behavioral therapies. Self-help documentation alone was less effective than face-to-face counseling. Community-based or workplace public interventions alone did not seem effective.

Discussion

Behavioral change strategies were effective in helping patients to give up smoking. BA alone was less effective than multiple session strategies although it required fewer resources. Evidence for community-based interventions effectiveness was weak, mainly due to the lack of robust studies.

Community pharmacy personnel interventions for smoking cessation

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.

The Role of Pharmacists in Cardiovascular Disease Prevention: Qualitative Studies from the United Kingdom and Greece

Objective:

In the United Kingdom (UK), cardiovascular disease (CVD) is the second main cause of death (27.4%) and the leading cause of death in Greece, accounting for 48% incidences. Pharmacists, the most accessible health-care professionals, can have a key role in all stages of CVD prevention. This study aimed to explore the current and future role of pharmacists in CVD prevention, focusing on two European countries, the United Kingdom and Greece.

Methods:

Semi-structured interviews were conducted with 40 community pharmacists; 20 in the UK and 20 in Greece. All interviews were audio-recorded, transcribed, and analyzed thematically.

Findings:

Five main themes were identified: current pharmacists' role, future pharmacists' role, communication, resources and tools, and knowledge. Whereas pharmacists in the UK use a patient-centered approach, Greek pharmacists use a paternalistic approach. Nevertheless, the majority found it difficult to initiate a consultation. Both the UK and Greek pharmacists primarily focus on secondary CVD prevention, while dispensing prescribed medications, which is their main current role. Greek pharmacists recognized a potential role in primary prevention and early screening of CVD through the initiation of CVD prevention services with a weight management program being proposed. Barriers identified for a role in CVD prevention included: high workload in Greece and reimbursement issues and interprofessional relations in the UK.

Conclusion:

Pharmacists in both countries perceive having a potential role in CVD prevention based on their accessibility and customer relations. The challenges include a closer working relationship with other clinicians, communication/consultation skills training, and developing a sustainable funding model for the service.

Evaluating NHS Stop Smoking Service engagement in community pharmacies using simulated smokers: fidelity assessment of a theory-based intervention

OBJECTIVES

Smokers are more likely to quit if they use the National Health Service (NHS) Stop Smoking Service (SSS). However, community pharmacies experience low service uptake. The Smoking Treatment Optimisation in Pharmacies (STOP) programme aims to address this problem by enhancing staff training using a theory-based intervention. In this study, we evaluated intervention fidelity using simulated smokers (actors) to assess smoker engagement and enactment of key intervention components by STOP trained staff.

DESIGN

An observational pilot study.

SETTINGS

Five community pharmacies in North East London with an NHS SSS.

METHODS

Six actors, representative of East London's population, were recruited and trained to complete intervention fidelity assessments. Consenting pharmacy staff from five participating pharmacies received STOP Intervention training. Four weeks after the staff training, the actors visited the participating pharmacies posing as smokers eligible for smoking cessation support. Engagement behaviour by pharmacy staff and enactment of intervention components was assessed using a scoring tool derived from the STOP logic model (scoring range of 0-36), and contemporaneous field notes taken by actors.

RESULTS

18 of 30 completed assessments were with STOP trained staff (10/18 were counter assistants). Mean score for smoker engagement was 24.4 (SD 9.0) points for trained and 16.9 (SD 7.8) for untrained staff, respectively. NHS SSS leaflets (27/30) were the most common smoking cessation materials seen on pharmacy visits. Most trained counter staff engaged with smokers using leaflets and a few proactively offered appointments with their cessation advisors. Appropriate use of body language was reported on 26/30 occasions alongside the use of key phrases from the STOP training session (n=8). Very few pharmacy staff wore STOP promotional badges (4/30).

CONCLUSIONS

STOP training may change client engagement behaviour in pharmacy staff and could improve the uptake of the NHS SSS. A cluster randomised controlled trial is currently in progress to evaluate its effectiveness and cost-effectiveness.

TRIAL REGISTRATION NUMBER

ISRCTN16351033.

Faculty perceptions of a tobacco cessation train-the-trainer workshop and experiences with implementation: A qualitative follow-up study

BACKGROUND

Between 2003 and 2005, pharmacy faculty members (n = 191) participated in a national train-the-trainer workshop designed to equip faculty with the necessary knowledge and skills to implement a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, at pharmacy schools across the United States.

OBJECTIVE

To conduct a long-term, qualitative follow-up study of faculty participants to describe (a) perceptions of the train-the-trainer workshop, and (b) subsequent experiences with curricular implementation. Results of this investigation will inform a national survey of all train-the-trainer participants.

METHODS

Participants were selected via random sampling from the group of 191 faculty members who participated in the workshop. Semi-structured telephone interviews with participants were audio-recorded and transcribed, and qualitative thematic analysis was conducted.

RESULTS

Eighteen (62%) of 29 invited individuals participated in the interviews. All participants reported implementing components of Rx for Change at their institution. The analysis yielded eight major themes pertaining to faculty perceptions and experiences with implementation: (1) accessibility to tools for teaching, (2) increased confidence and skills, (3) flexibility delivering the curriculum, (4) factors facilitating implementation and challenges encountered by faculty, (5) enhancement in treating tobacco users in clinical practice, (6) students' confidence and cognizance of the pharmacists' role as a public health advocate, (7) networking and career development opportunities, and (8) useful background for research.

CONCLUSION

Participation in the train-the-trainer workshop increased self-reported confidence for teaching tobacco cessation, and faculty valued access to useful, updated tools for teaching. Furthermore, their newly acquired counseling skills were deemed helpful for treating patients' tobacco use and dependence in clinical practice. Participants also perceived improved pharmacy students' confidence and beneficial networking opportunities. Results can help future trainers understand faculty experiences with implementing a shared, national curriculum and inform faculty participants of some of the potential long-term outcomes as a result of participation.

Barriers to promote cardiovascular health in community pharmacies: a systematic review

Community pharmacists play an important role in the provision of health promotion services, and community pharmacies are considered as a potentially ideal site for cardiovascular health promotion. Information based on a systematic review of barriers to promoting cardiovascular health in community pharmacy is currently lacking. We have sought to identify the most important barriers to cardiovascular health promotion in the community pharmacy. We have systematically searched PubMed and International Pharmaceutical Abstracts for a period of 15 years from 1 April 1998 to 1 April 2013, contacted subject experts and hand-searched bibliographies. We have included peer-reviewed articles, with English abstracts in the analysis, if they reported community pharmacists' perceptions of the barriers to cardiovascular health promotion activities in a community pharmacy setting. Two reviewers have independently extracted study characteristics and data. We identified 24 studies that satisfy the eligibility criteria. The main barriers to cardiovascular health promotion in the community pharmacy included pharmacist-related factors; practice site factors; financial factors; legal factors; and patient-related factors. This review will help to provide reliable evidence for health promotion practitioners of the barriers to promoting cardiovascular health in the community pharmacy setting. This knowledge is valuable for the improvement of cardiovascular health promotion in this setting and guiding future research.

Equipping community pharmacy workers as agents for health behaviour change: developing and testing a theory-based smoking cessation intervention

OBJECTIVE

To develop a complex intervention for community pharmacy staff to promote uptake of smoking cessation services and to increase quit rates.

DESIGN

Following the Medical Research Council framework, we used a mixed-methods approach to develop, pilot and then refine the intervention.

METHODS

Phase I: We used information from qualitative studies in pharmacies, systematic literature reviews and the Capability, Opportunity, Motivation-Behaviour framework to inform design of the initial version of the intervention. Phase II: We then tested the acceptability of this intervention with smoking cessation advisers and assessed fidelity using actors who visited pharmacies posing as smokers, in a pilot study. Phase III: We reviewed the content and associated theory underpinning our intervention, taking account of the results of the earlier studies and a realist analysis of published literature. We then confirmed a logic model describing the intended operation of the intervention and used this model to refine the intervention and associated materials.

SETTING

Eight community pharmacies in three inner east London boroughs.

PARTICIPANTS

12 Stop Smoking Advisers.

INTERVENTION

Two, 150 min, skills-based training sessions focused on communication and behaviour change skills with between session practice.

RESULTS

The pilot study confirmed acceptability of the intervention and showed preliminary evidence of benefit; however, organisational barriers tended to limit effective operation. The pilot data and realist review pointed to additional use of Diffusion of Innovations Theory to seat the intervention in the wider organisational context.

CONCLUSIONS

We have developed and refined an intervention to promote smoking cessation services in community pharmacies, which we now plan to evaluate in a randomised controlled trial.

TRIAL REGISTRATION NUMBER

UKCRN ID 18446, Pilot.

Involvement of community pharmacists in public health priorities: A multi-center descriptive survey in Ethiopia

Located in the heart of the community and widely distributed geographically, community pharmacies provide a platform for a more proactive involvement in public health services. So far, little information has been gathered in Ethiopia on community pharmacists’ level of involvement in public health services. The aim of the present study was, therefore, to document the level of involvement of community pharmacy professionals in the provision of public health services and the barriers to such involvement. This study employed a self-administered questionnaire based survey, which asked participants to indicate their frequency and level of involvement in providing public health services and their perceived barriers in providing such services. Surveys were undertaken from May to July, 2016 with 472 community pharmacy professionals working in community pharmacies in six cities of Amhara regional state of Ethiopia: Debre Markos, Gondar, Dessie, Bahir Dar, Woldya and Debre Birhan. Among 472 community pharmacy professionals approached, 412 (233 pharmacists and 179 pharmacy technicians) completed the survey with a response rate of 87.3%. Most respondents reported as being either “not at all involved” or “little involved” in counselling on smoking cessation (79.3%), and screening for hypertension (86.9%), diabetes (89.5%), and dyslipidemia (88.9%). On the other hand, they reported a higher level of involvement in the management and screening of infectious diseases (72.8%) and counseling with partners when initiating treatment for sexually transmitted diseases (68.9%). Lack of knowledge or clinical skills and lack of personnel or resources were the most commonly reported barrier for expanding such services. This survey revealed a low level of involvement of community pharmacists in public health services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of community pharmacy professionals, interventions should focus on overcoming the identified barriers.

A Systematic Review of Evidence-Based Community Pharmacy Services Aimed at the Prevention of Cardiovascular Disease

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death worldwide and has a substantial impact on people's health and quality of life. CVD also causes an increased use of health care resources and services, representing a significant proportion of health care expenditure. Integrating evidence-based community pharmacy services is seen as an asset to reduce the burden of CVD on individuals and the health care system.

OBJECTIVES

To (a) identify community pharmacy evidence-based services designed to help prevent CVD and (b) provide fundamental information that is needed to assess their potential adaptation to other community pharmacy settings.

METHODS

This review used the DEPICT database, which includes 488 randomized controlled trials (RCT) that address the evaluation of pharmacy services. Articles reviewing these RCTs were identified for the DEPICT database through a systematic search of the following databases: MEDLINE, Scopus, SciELO (Scientific Electronic Library Online), and DOAJ (Directory of Open Access Journals). The DEPICT database was reviewed to identify evidence-based services delivered in the community pharmacy setting with the purpose of preventing CVD. An evidence-based service was defined as a service that has been shown to have a positive effect (compared with usual care) in a high-quality RCT. From each evidence-based service, fundamental information was retrieved to facilitate adaptation to other community pharmacy settings.

RESULTS

From the DEPICT database, 14 evidence-based community pharmacy services that addressed the prevention of CVD were identified. All services, except 1, targeted populations with a mean age above 60 years. Pharmacy services encompassed a wide range of practical applications or techniques that can be classified into 3 groups: activities directed at patients, activities directed at health care professionals, and assessments to gather patient-related information in order to support the previous activities.

CONCLUSIONS

This review provides pharmacy service planners and policymakers with a comprehensive list of evidence-based services that have the potential to be adapted to different settings from which they were originally implemented and evaluated in order to reduce the burden of CVD.

DISCLOSURES

Funding for this review was provided by the University of Technology Sydney Chancellor's Postdoctoral Fellowship awarded to Sabater-Hernández. No other potential conflict of interest was declared. Study concept and design were contributed by Sabater-Hernández, Fernandez-Llimos, Rotta, and Correr. Sabater-Galindo and Sabater-Hernández took the lead in data collection, along with Franco-Trigo and Rotta. Data interpretation was performed by Sabater-Hernández, Durks, and Lopes. The manuscript was written primarily by Sabater-Hernández, along with Hossain, and revised by Fernandez-Llimos, Rotta, and Benrimoj, with assistance from Durks, Sabater-Galindo, Franco-Trigo, and Correr.

Effectiveness of a pharmacist-delivered smoking cessation program in the State of Qatar: a randomized controlled trial

Background

Cigarette smoking is one of the major preventable causes of death and diseases in Qatar. The study objective was to test the effect of a structured smoking cessation program delivered by trained pharmacists on smoking cessation rates in Qatar.

Methods

A prospective randomized controlled trial was conducted in eight ambulatory pharmacies in Qatar. Eligible participants were smokers 18 years and older who smoked one or more cigarettes daily for 7 days, were motivated to quit, able to communicate in Arabic or English, and attend the program sessions. Intervention group participants met with the pharmacists four times at 2 to 4 week intervals. Participants in the control group received unstructured brief smoking cessation counseling. The primary study outcome was self-reported continuous abstinence at 12 months. Analysis was made utilizing data from only those who responded and also using intent-to-treat principle. A multinomial logistic regression model was fitted to assess the predictors of smoking at 12 months. Analysis was conducted using IBM-SPSS® version 23 and STATA® version 12.

Results

A total of 314 smokers were randomized into two groups: intervention (n = 167) and control (n = 147). Smoking cessation rates were higher in the intervention group at 12 months; however this difference was not statistically significant (23.9% vs. 16.9% p = 0.257). Similar results were observed but with smaller differences in the intent to treat analysis (12.6% vs. 9.5%, p = 0.391). Nevertheless, the daily number of cigarettes smoked for those who relapsed was significantly lower (by 4.7 and 5.6 cigarettes at 3 and 6 months respectively) in the intervention group as compared to the control group (p = 0.041 and p = 0.018 respectively). At 12 months, the difference was 3.2 cigarettes in favor of the intervention group but was not statistically significant (p = 0.246). Years of smoking and daily number of cigarettes were the only predictors of smoking as opposed to quitting at 12 months (p = 0.005; p = 0.027 respectively).

Conclusions

There was no statistically significant difference in the smoking cessation rate at 12 months between the groups. However, the smoking cessation program led to higher (albeit non-significant) smoking cessation rates compared with usual care. More research should be conducted to identify factors that might improve abstinence.

Trial registration

Clinical Trials NCT02123329. Registration date 20 April 2014

What works for whom in pharmacist-led smoking cessation support: realist review

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.

Assessment of Assistance in Smoking Cessation Therapy by Pharmacies in Collaboration with Medical Institutions- Implementation of a Collaborative Drug Therapy Management Protocol Based on a Written Agreement between Physicians and Pharmacists

This study built a protocol for drug therapy management (hereinafter "the protocol") that would enable continuous support from the decision making of smoking cessation therapy to the completion of therapy through the collaboration of physicians and community pharmacists, after which we evaluated whether the use of this protocol would be helpful to smoking cessation therapy. This study utilized the "On the Promotion of Team-Based Medical Care", a Notification by the Health Policy Bureau as one of the resources for judgment, and referred to collaborative drug therapy management (CDTM) in the United States. After the implementation of this protocol, the success rate of smoking cessation at the participating medical institutions rose to approximately 70%, approximately 28-point improvement compared to the rate before the implementation. In addition to the benefits of the standard smoking cessation program, this result may have been affected by the intervention of pharmacists, who assisted in continuing cessation by advising to reduce drug dosage as necessary approximately one week after the smoking cessation, when side effects and the urge to smoke tend to occur. Additionally, the awareness survey for the intervention group revealed that all respondents, including patients who failed to quit smoking, answered that they were satisfied to the question on general satisfaction. The question about the reason for successful cessation revealed that the support by pharmacists was as important as, or more important than, that by physicians and nurses. This infers that the pharmacists' active engagement in drug therapy for individual patients was favorably acknowledged.

An Elective Course to Train Student Pharmacists to Deliver a Community-based Group Diabetes Prevention Program

Objective. To develop and assess the impact of an elective course aimed at improving student knowledge of and confidence in delivering a group diabetes prevention program. Design. Two colleges of pharmacy collaborated to develop a 2-credit elective course using didactic and active-learning strategies to prepare students to serve as lifestyle coaches offering a proven group diabetes prevention program. Assessment. Students' confidence in their ability to deliver a group diabetes prevention program increased as a result of the class. However, their knowledge of diabetes prevention facts was unchanged from baseline. Conclusion. A diabetes prevention elective course improved students' confidence in their ability to teach a diabetes prevention program.

On the Front Line of Smoking Cessation: Education Needs of Community Pharmacists

Background:

Nicotine replacement therapy (NRT) is now available without prescription, and pharmacists have an opportunity to be the primary health care professionals advising patients who want to try this smoking cessation aid. Undergraduate pharmacy education in Canada incorporates some tobacco-related training, and continuing education opportunities are available. However, there are no published reports of the self-reported educational needs of a broad sample of practising Canadian community pharmacists with regard to smoking cessation.

Methods:

Practising community pharmacists in four Canadian provinces were surveyed about their tobacco-related education and knowledge, practice environment, practices related to helping people quit smoking, needs for further information and training, and methods by which this information might be delivered.

Results:

A corrected response rate of 72% was obtained, giving a weighted n of 960 responses. Most Canadian community pharmacists reported that they would find it helpful to receive additional information or training on a wide range of smoking cessation topics, such as behavioural counselling techniques and motivating patients to quit. Pharmacists who reported that they were familiar with aids such as Helping Your Patients Quit Smoking: A Cessation Guide for Pharmacists (Canadian Pharmacists Association) and who reported that the guide had led them to make changes in their practice were more likely to report that additional information or training would be helpful. Pharmacists who perceived their tobacco-related clinical and non-clinical roles to be important were more likely to report that additional training would be helpful than were those who perceived these roles as less important.

Conclusions:

Although most Canadian community pharmacists would find it helpful to receive additional smoking-related information and training, those who perceive this to be an important activity and who are already using available materials showed the most interest. The challenge to Canadian pharmacy educators is to encourage the enthusiasm of those already interested in helping their patients to quit smoking, while raising the level of interest and motivation among all community pharmacists.

Reasons for electronic cigarette use beyond cigarette smoking cessation: A concept mapping approach

INTRODUCTION

Electronic cigarettes (ECIGs) continue to grow in popularity, however, limited research has examined reasons for ECIG use.

METHODS

This study used an integrated, mixed-method participatory research approach called concept mapping (CM) to characterize and describe adults' reasons for using ECIGs. A total of 108 adults completed a multi-module online CM study that consisted of brainstorming statements about their reasons for ECIG use, sorting each statement into conceptually similar categories, and then rating each statement based on whether it represented a reason why they have used an ECIG in the past month.

RESULTS

Participants brainstormed a total of 125 unique statements related to their reasons for ECIG use. Multivariate analyses generated a map revealing 11, interrelated components or domains that characterized their reasons for use. Importantly, reasons related to Cessation Methods, Perceived Health Benefits, Private Regard, Convenience and Conscientiousness were rated significantly higher than other categories/types of reasons related to ECIG use (p<.05). There also were significant model differences in participants' endorsement of reasons based on their demography and ECIG behaviors.

CONCLUSIONS

This study shows that ECIG users are motivated to use ECIGs for many reasons. ECIG regulations should address these reasons for ECIG use in addition to smoking cessation.

Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions

Background

The Department of Health has identified interventions to manage alcohol misuse, smoking and overweight, delivered by community pharmacists, as public health priorities.

Objectives

To systematically review the effectiveness of community pharmacy interventions to manage alcohol misuse, smoking cessation and weight loss; to explore if and how age, sex, ethnicity and socioeconomic status moderate effectiveness; and to describe how the interventions have been organised, implemented and delivered.

Data sources

Ten electronic databases were searched: Applied Social Sciences Index and Abstracts; Cumulative Index to Nursing and Allied Health Literature; EMBASE; International Bibliography of the Social Sciences; MEDLINE; NHS Economic Evaluation Database; PsycINFO; Social Science Citation Index; Scopus; and the Sociological Abstracts from inception to May 2014. There was no restriction on language or country. Supplementary searches included website, grey literature, study registers, bibliographies and contacting experts.

Review methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Any type of intervention of any duration based in any country and in people of any age was included. The review included interventions set in a community pharmacy and delivered by the pharmacist or the wider pharmacy team. Randomised controlled trials, non-randomised controlled trials, controlled before-and-after studies and interrupted time series studies were included. Data extraction and quality assessment were conducted independently for each study by two reviewers. Meta-analysis and narrative synthesis were also conducted.

Results

The searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. Pharmacy-based smoking cessation interventions including behavioural support and/or nicotine replacement therapy are effective and cost-effective in helping adults to stop smoking, particularly when compared with usual care. The pooled odds ratio of the intervention effects for smoking cessation was 1.85 (95% confidence interval 1.25 to 2.75). It is currently unknown which specific types of smoking cessation interventions are the most effective. There was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions. Evidence suggests that pharmacy-based weight-loss interventions are as effective as similar interventions in other primary care settings, but not as effective or cost-effective as commercially provided weight management services based in community settings. None of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.

Limitations

The information reported in the publications of included studies did not allow us to assess in detail if and how age, sex, ethnicity and socioeconomic status moderate effectiveness, or to describe how the interventions had been organised, implemented and delivered.

Conclusions

Community pharmacy interventions are effective for smoking cessation. Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. The effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness.

Study registration

This study is registered as PROSPERO CRD42013005943.

Funding

The National Institute for Health Research Public Health Research programme.

Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation

OBJECTIVES

To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management.

DESIGN

Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

STUDY DESIGN

randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series.

INTERVENTION

any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language.

RESULTS

19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 'strong', 4 'moderate' and 9 'weak'. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions.

CONCLUSIONS

Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services.

Suitability of a Group Behavioural Therapy Module for Workplace Smoking Cessation Programs in Malaysia: a Pilot Study

In Malaysia, data on components suitability the established smoking cessation module is limited. This exploratory study aimed to evaluate the suitability of the components developed in the module for group behavioural therapy in workplace smoking cessation programs. Twenty staff were identified but only eight individuals were selected according to the study criteria during the recruitment period in May 2014. Focus group discussion was conducted to identify themes relevant to the behavioural issues among smokers. Thematic analysis yielded seven major themes which were reasons for regular smoking, reasons for quitting, comprehending smoking characteristics, quit attempt experiences, support and encouragement, learning new skills and behaviour, and preparing for lapse/relapse or difficult situations. As a result, the developed module was found to be relevant and suitable for use based on these themes.

Intervention fidelity for a complex behaviour change intervention in community pharmacy addressing cardiovascular disease risk

Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists for behavioural components of a complex educational intervention for CVD prevention. After receiving training to improve lifestyle and medicines adherence, pharmacists recruited 70 patients aged 50-74 years without established CVD, and taking antihypertensive or lipid lowering therapy. Patients received five counselling sessions, each at monthly intervals. Researchers assessed biomedical and behavioural risk factors at baseline and six months. Pharmacists documented key outcomes from counselling after each session. Most patients (86%) reported suboptimal cardiovascular diets, 41% reported suboptimal medicines adherence, and 39% were physically inactive. Of those advised to complete the intervention, 85% attended all five sessions. Pharmacists achieved patient agreement with most recommended goals for behaviour change, and overwhelmingly translated goals into practical behavioural strategies. Barriers to changing behaviours were regularly documented, and pharmacists reported most behavioural strategies as having had some success. Meaningful improvements to health behaviours were observed post-intervention. Findings support further exploration of pharmacists' potential roles for delivering interventions with complex behaviour change requirements.

Pharmacists' Perceptions of Tobacco Sales in an Elevated-Risk Population

Background: Policies by the American Medical Association and the American Pharmacists Association advocate for the discontinuation of tobacco sales in pharmacies, yet tobacco sales remain lucrative for pharmacies in the United States. West Virginia has the highest smoking rate (29%) and the second highest lung cancer incidence in the country. Objective: This study examined pharmacists' perceptions of tobacco sales in pharmacies and awareness of relevant policies. Methods: West Virginia pharmacists (n = 195) were surveyed to understand tobacco sales in West Virginia pharmacy, utilizing Diffusion of Innovations as a theoretical framework. Results: Eighty-one percent were community pharmacists, and 39% practiced at independent pharmacies. Sixty-two percent reported that their pharmacies did not sell tobacco. Pharmacists at independent pharmacies were more likely to be in rural areas/small towns, have decision-making control over tobacco sales, and not currently selling tobacco products. Other community pharmacists (ie, at regional and national chains) were more likely to sell tobacco products, not have decision-making control over tobacco sales, and perceive revenue loss from discontinuing tobacco sales. Other types of pharmacists (eg, hospital) estimated a greater number of patients who were smokers/tobacco users. A logistic regression showed that less perceived revenue loss was associated with greater likelihood of not selling tobacco products (all Ps < .05). Conclusions: Findings indicate a strong movement among community pharmacists to curtail the use of tobacco. Generating support for the elimination of tobacco sales and adoption of tobacco cessation initiatives in community pharmacy could help reduce smoking rates in elevated-risk populations.

Assessing the effectiveness of a pharmacist-delivered smoking cessation program in the State of Qatar: study protocol for a randomized controlled trial

BACKGROUND

It had been reported that up to 37% of the adult male population smokes cigarettes in Qatar. The Global Youth Tobacco Survey also stated that 13.4% of male school students aged 13 to 15 years in Qatar smoke cigarettes. Smoking cessation is key to reducing smoking-related diseases and deaths. Healthcare providers are in an ideal position to encourage smoking cessation. Pharmacists are the most accessible healthcare providers and are uniquely situated to initiate behavior change among patients. Many studies have shown that pharmacists can be successful in helping patients quit smoking. Studies demonstrating the effectiveness of pharmacist-delivered smoking cessation programs are lacking in Qatar. This proposal aims to test the effect of a structured smoking cessation program delivered by trained ambulatory pharmacists in Qatar.

METHODS/DESIGN

A prospective, randomized, controlled trial is conducted at eight ambulatory pharmacies in Qatar. Participants are randomly assigned to receive an at least four-session face-to-face structured patient-specific smoking cessation program conducted by the pharmacist or 5 to 10 min of unstructured brief smoking cessation advice (emulating current practice) given by the pharmacist. Both groups are offered nicotine replacement therapy if feasible. The primary outcome of smoking cessation will be confirmed by an exhaled carbon monoxide test at 12 months. Secondary outcomes constitute quality-of-life adjustment as well as cost analysis of program resources consumed, including per case and patient outcome.

DISCUSSION

If proven to be effective, this smoking cessation program will be considered as a model that Qatar and the region can apply to decrease the smoking burden.

TRIAL REGISTRATION

Clinical Trials NCT02123329 .

Cluster-Randomized Trial of Clinical Pharmacist Tobacco Cessation Counseling Among Patients with Cardiovascular Disease

Optimal management of patients with cardiovascular disease (CVD) includes evaluation of risk factors using a team-based approach. Tobacco use often receives less attention than other CVD risk factors; therefore, utilization of nonphysician health care providers may be valuable in addressing tobacco use. The purpose of this trial was to assess the impact of brief, structured, telephone tobacco cessation counseling (BST) delivered by clinical pharmacists on tobacco cessation attempts compared to usual care. The BST consisted of 1 to 5 minutes discussing 3 key counseling points, including a recommendation to quit and education about cessation aids. This was a cluster-randomized trial of tobacco-using patients with CVD who were enrolled in a clinical pharmacist-managed, physician-directed, CVD disease state management service. Clinical pharmacists were randomized to provide usual care (control) or BST (intervention) to their tobacco-using patients during a 4-month period. Patients were surveyed 3 months later to assess their tobacco cessation attempts, use of tobacco cessation aids, and self-reported cessation. One hundred twenty patients were enrolled. Subjects were predominately white males, aged ≥65 years, with a history of myocardial infarction. One hundred and four subjects completed the follow-up survey. No differences were detected between the 36.2% and 38.6% of control and intervention subjects, respectively, reporting a tobacco cessation attempt (P=0.804) or in the other outcomes (all P>0.05). A BST delivered by clinical pharmacists may not adequately affect patient motivation enough to increase tobacco cessation attempts in tobacco-dependent patients with CVD. Future research is needed to evaluate other team-based strategies that can decrease tobacco use in patients with CVD.

Treatment Outcome Assessment of the Pharmacist-Managed Quit Smoking Clinic in Malaysia

Introduction: Evaluating a new health service is different from evaluating a new drug, as the former depends on the local delivery structure and culture. No data are available on the effectiveness of the existing pharmacist-managed quit smoking clinic (PM-QSC) in Malaysia. We evaluated the effectiveness in terms of the quit and default rate, the cost per quitter, cost per patient and the number of days of the patient remained in the managed care of the pharmacist.

Methods: The patients’ medical records at the PM-QSC in a tertiary hospital in Melaka, Malaysia, were examined retrospectively from January 2009 to December 2010. Patients were grouped into current smokers, attempted to quit and quitters. Costs were calculated per patient visit on the basis of resource used (smoking cessation agents (SCAs)) and the personnel involved (time spent by the pharmacist). This study was reviewed and approved by the Malaysia Research Ethics Committee (MREC).

Results: The quit rate between January 2009 and December 2010 was 5.8%, and the default rate was 71.8%. The average quit period for all smokers enrolled was 298 days. From the health provider perspective, the average costs per quitter, per patient and per quit attempt were MYR 953.28 (USD 308), MYR 55.71 (USD 18) and MYR 34.74 (USD 11), respectively.

Conclusion: The pharmacist delivery of cessation services at a public-funded QSC was associated with a high default rate. The pharmacist could not be dismissed entirely as an ineffective health care professional (HCP) for the provision of the cessation service based solely on this preliminary data, but these findings stress the need to address the high default rate prior to the expansion of the service.

Assessment of pharmacist-led patient counseling in randomized controlled trials: a systematic review

Background Pharmacists' counseling has improved health-related outcomes in many acute and chronic conditions. Several studies have shown how pharmacists have been contributing to reduce morbidity and mortality related to drug-therapy (MMRDT). However, there still is a lack of reviews that assemble evidence-based clinical pharmacists' counseling. Equally, there is also a need to understand structure characteristics, processes and technical contents of these clinical services. Aim of the review To review the structure, processes and technical contents of pharmacist counseling or education reported in randomized controlled trials (RCT) that had positive health-related outcomes. Methods We performed a systematic search in specialized databases to identify RCT published between 1990 and 2013 that have evaluated pharmacists' counseling or educational interventions to patients. Methodological quality of the trials was assessed using the Jadad scale. Pharmacists' interventions with positive clinical outcomes (p < 0.05) were evaluated according to patients' characteristics, setting and timing of intervention, reported written and verbal counseling. Results 753 studies were found and 101 RCT matched inclusion criteria. Most of the included RCTs showed a Jadad score between two (37 studies) and three (32 studies). Pharmacists were more likely to provide counseling at ambulatories (60 %) and hospital discharge (25 %); on the other hand pharmacists intervention were less likely to happen when dispensing a medication. Teaching back and explanations about the drug therapy purposes and precautions related to its use were often reported in RCT, whereas few studies used reminder charts, diaries, group or electronic counseling. Most of studies reported the provision of a printed material (letter, leaflet or medication record card), regarding accessible contents and cultural-concerned informations about drug therapy and disease. Conclusion Pharmacist counseling is an intervention directed to patients' health-related needs that improve inter-professional and inter-institutional communication, by collaborating to integrate health services. In spite of reducing MMRDT, we found that pharmacists' counseling reported in RCT should be better explored and described in details, hence collaborating to improve medication-counseling practice among other countries and settings.

Assessment of pharmacist-led patient counseling in randomized controlled trials: a systematic review

Background Pharmacists' counseling has improved health-related outcomes in many acute and chronic conditions. Several studies have shown how pharmacists have been contributing to reduce morbidity and mortality related to drug-therapy (MMRDT). However, there still is a lack of reviews that assemble evidence-based clinical pharmacists' counseling. Equally, there is also a need to understand structure characteristics, processes and technical contents of these clinical services. Aim of the review To review the structure, processes and technical contents of pharmacist counseling or education reported in randomized controlled trials (RCT) that had positive health-related outcomes. Methods We performed a systematic search in specialized databases to identify RCT published between 1990 and 2013 that have evaluated pharmacists' counseling or educational interventions to patients. Methodological quality of the trials was assessed using the Jadad scale. Pharmacists' interventions with positive clinical outcomes (p < 0.05) were evaluated according to patients' characteristics, setting and timing of intervention, reported written and verbal counseling. Results 753 studies were found and 101 RCT matched inclusion criteria. Most of the included RCTs showed a Jadad score between two (37 studies) and three (32 studies). Pharmacists were more likely to provide counseling at ambulatories (60 %) and hospital discharge (25 %); on the other hand pharmacists intervention were less likely to happen when dispensing a medication. Teaching back and explanations about the drug therapy purposes and precautions related to its use were often reported in RCT, whereas few studies used reminder charts, diaries, group or electronic counseling. Most of studies reported the provision of a printed material (letter, leaflet or medication record card), regarding accessible contents and cultural-concerned informations about drug therapy and disease. Conclusion Pharmacist counseling is an intervention directed to patients' health-related needs that improve inter-professional and inter-institutional communication, by collaborating to integrate health services. In spite of reducing MMRDT, we found that pharmacists' counseling reported in RCT should be better explored and described in details, hence collaborating to improve medication-counseling practice among other countries and settings.

Pharmaceutical care for patients with COPD in Belgium and views on protocol implementation

BACKGROUND

A protocol-based pharmaceutical care program (the PHARMACOP-protocol) focusing on patient counselling during prescription filling has shown to be effective in patients with chronic obstructive pulmonary disease (COPD). However, implementation of this protocol in daily practice has not yet been studied.

OBJECTIVE

To describe current implementation level of the items included in the PHARMACOP-protocol in Belgian community pharmacies and to evaluate pharmacists' perspectives on the implementation of this protocol in daily practice.

METHOD

A cross-sectional study was conducted from April to June 2012, in randomly selected community pharmacies in Flanders. Pharmacists were questionned using structured interviews.

RESULTS

125 pharmacies were contacted and 80 managing pharmacists (64 %) participated. In >70 % of pharmacies, 4/7 protocol items for first prescriptions and 3/5 protocol items for follow-up prescriptions were already routinely implemented. For first and follow-up prescriptions, respectively 39 (49 %) and 34 pharmacists (43 %) stated they would need to spend at least 5 min extra to offer optimal patient counselling. Most mentioned barriers preventing protocol implementation included lack of time (80 %), no integration in pharmacy software (61 %) and too much administrative burden (58 %).

CONCLUSION

Approximately 50 % of the PHARMACOP-protocol items are currently routinely provided in Belgian community pharmacies. Nearly all interviewed pharmacists are willing to implement the protocol fully or partially in daily practice.

Effectiveness of tobacco use cessation interventions delivered by pharmacy personnel: a systematic review

BACKGROUND

Tobacco use remains the leading cause of preventable morbidity and mortality. Implementation of tobacco use cessation interventions however requires strategies that reach large proportions of the population. Pharmacy personnel are therefore a potential human resource for delivering tobacco use cessation interventions.

OBJECTIVE

This review aimed to identify, describe and synthesis currently available evidence on the effectiveness of tobacco use cessation interventions delivered by pharmacy personnel.

METHODS

The following electronic databases were searched for studies published until May 2012: MEDLINE, EMBASE, PSYCINFO, Cochrane Library, Web of Knowledge and the Current Controlled Trials Register. This review considered controlled clinical trials and randomized controlled trials, which were comparing any pharmacy personnel delivered tobacco use cessation intervention to no treatment, usual care or other active treatments. The outcomes of interest were: abstinence (e.g., point prevalence; continuous abstinence) and relapse (e.g., time to relapse) as measured by the respective studies. The results were not pooled due to high levels of clinical heterogeneity.

RESULTS

Ten eligible studies with a total of 20,133 participants were identified. Results suggest pharmacy personnel delivered non-pharmacological interventions offering behavioral counseling or support for tobacco use cessation could be beneficial, particularly from 6 months follow-up onwards. Combining these non-pharmacological with pharmacological interventions could also be beneficial. The results for the effectiveness of nicotine replacement therapy (NRT) were mixed with some findings suggesting intervention benefits, and others suggesting no clear benefit.

CONCLUSIONS

Pharmacy personnel-delivered non-pharmacological tobacco use cessation interventions offering behavioral counseling or support, and those combining these non-pharmacological interventions with NRT/pharmacological approaches, are potentially effective. No clear benefit has been demonstrated on pharmacy personnel-delivered NRT interventions. However, these findings are based on a very limited number of studies and hence more evidence is needed before more robust conclusions can be made.