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STOP- a training intervention to optimise treatment for smoking cessation in community pharmacies: cluster randomised controlled trial. BMC Med 2022; 20:212. [PMID: 35761321 PMCID: PMC9238035 DOI: 10.1186/s12916-022-02412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Community pharmacies serve people with high levels of tobacco-related illness, but throughput in NHS Stop Smoking Services in pharmacies remains relatively low. We investigated the effectiveness of a complex intervention to increase service uptake and retention. METHODS We randomised 60 pharmacies in England and Wales to the STOP intervention or usual practice in a pragmatic, parallel-group, controlled trial over 11 months. Smokers were blind to the allocation. The intervention was theory-based consultation skills training for pharmacy staff with environmental prompts (badges, calendars and behavioural cues). The primary outcome was the number of smokers attending an initial consultation and setting a quit date. RESULTS The intervention made no significant difference in setting a quit date, retention or quit rate. A total of 631 adult smokers (service users) enrolled and set a quit date in intervention pharmacies compared to 641 in usual practice pharmacies, a rate ratio of 0.75 (95% CI 0.46 to 1.23) adjusted for site and number of prescriptions. A total of 432 (68%) service users were retained at 4 weeks in intervention and 500 (78%) in usual practice pharmacies (odds ratio 0.80, 0.41 to 1.55). A total of 265 (42%) service users quit smoking at 4 weeks in intervention and 276 (43%) in usual practice pharmacies (0.96, 0.65 to 1.43). The pharmacy staff were positive about the intervention with 90% (56/62) stating that it had improved their skills. Sixty-eight per cent would strongly recommend the training to others although there was no difference in self-efficacy for service delivery between arms. Seventy of 131 (53%) service users did not complete the 6-month follow-up assessment. However, 55/61 (90%) service users who completed follow-up were satisfied or very satisfied with the service. All usual practice arm service users (n = 33) and all but one in the intervention arm (n = 27) would recommend the service to smokers. CONCLUSIONS We found high levels of retention and acceptable quit rates in the NHS pharmacy stop smoking service. Despite pharmacy staff providing positive feedback on the STOP intervention, it made no difference to service throughput. Thus, other factors may currently limit service capacity to help smokers to quit. TRIAL REGISTRATION ISRCTN, ISRCTN16351033 . Retrospectively registered.
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Alsubaie S, Grant D, Donyai P. The utility of Conversation Analysis versus Roter's Interaction Analysis System for studying communication in pharmacy settings: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 30:17-27. [PMID: 34741506 DOI: 10.1093/ijpp/riab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To compare the usefulness of the Roter Interaction Analysis System with Conversation Analysis (CA) for studying dynamic patient-pharmacist interactions within pharmacy practice. A scoping review was undertaken to identify all studies using Roter's method or CA to investigate patient-pharmacist interactions. The studies were then compared and contrasted for their methodological advantages and disadvantages. KEY FINDINGS In total, 31 studies met the inclusion criteria. Roter's method is effective in briefly describing patient-pharmacist interactions and can be used to measure the effect of training courses without consuming too much time. CA, although a time-consuming undertaking, looks at very specific features and the sequence of conversations including the dynamics of two-way interactions and can therefore be used to identify the source of conflict or misunderstandings. A flowchart showing the usefulness of both methods is suggested to help other researchers select the appropriate method(s) for their own research. SUMMARY Although both methods are effective for investigating patient-pharmacist interactions independently, using them sequentially could enable researchers to firstly identify how to make improvements (via CA), design relevant training and then investigate the impact of such training (via Roter's method) to enrich communications research.
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Affiliation(s)
- Sarah Alsubaie
- School of Pharmacy, University of Reading, Whiteknights Campus, Reading, UK
| | - Daniel Grant
- School of Pharmacy, University of Reading, Whiteknights Campus, Reading, UK
| | - Parastou Donyai
- School of Pharmacy, University of Reading, Whiteknights Campus, Reading, UK
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Sohanpal R, Jumbe S, James WY, Steed L, Yau T, Rivas C, Madurasinghe V, Houlihan C, Berdunisov V, Taylor M, Taylor SJC, Griffiths C, Eldridge S, Walton R. Evaluating the effectiveness and cost-effectiveness of the Smoking Treatment Optimisation in Pharmacies (STOP) intervention: protocol for a cluster randomised controlled trial. Trials 2019; 20:337. [PMID: 31182134 PMCID: PMC6558670 DOI: 10.1186/s13063-019-3368-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/15/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND NHS community pharmacies provide effective smoking cessation services; however, there is scope for increasing throughput and improving quit rates. This trial examines whether the Smoking Treatment Optimisation in Pharmacies (STOP) intervention can improve smoker engagement to increase service throughput, retention and quitting. METHODS This study is a pragmatic, cluster randomised controlled trial in 60 pharmacies in England and Wales. All workers in intervention pharmacies are offered STOP training while control pharmacies provide usual care. The STOP intervention, based on behavioural and organisational theories, comprises educational sessions for staff and environmental prompts in the pharmacy. Intervention fidelity is assessed by actors visiting pharmacies posing as smokers. The primary outcome is throughput, defined as the number of smokers who join the programme, set a firm quit date and undergo at least one stop smoking treatment session, and is measured using routinely collected data. Secondary outcomes include retention and quit rates at 4 weeks and continuous abstinence at 6 months verified by salivary cotinine. Cost-effectiveness is estimated using quality-adjusted life years and the probability that the intervention is effective at different levels of willingness to pay is calculated. DISCUSSION The trial will generate evidence to inform the public health smoking cessation strategy in England and Wales, and may help to shape service commissioning decisions. The STOP intervention model may help inform the undertaking of a range of health behaviour change tasks in community pharmacies. TRIAL REGISTRATION ClinicalTrials.gov, ISRCTN16351033. Retrospectively registered on 21 March 2017.
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Affiliation(s)
- Ratna Sohanpal
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Jumbe
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Wai-Yee James
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liz Steed
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tammy Yau
- California Northstate University, 9700 West Taron Drive, Elk Grove, CA 95757 USA
| | - Carol Rivas
- Institute of Education, University College London, London, UK
| | - Vichithranie Madurasinghe
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Colin Houlihan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vlad Berdunisov
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew Taylor
- York Health Economics Consortium, University of York, York, UK
| | - Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert Walton
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Jumbe S, James WY, Madurasinghe V, Steed L, Sohanpal R, Yau TK, Taylor S, Eldridge S, Griffiths C, Walton R. Evaluating NHS Stop Smoking Service engagement in community pharmacies using simulated smokers: fidelity assessment of a theory-based intervention. BMJ Open 2019; 9:e026841. [PMID: 31110097 PMCID: PMC6530322 DOI: 10.1136/bmjopen-2018-026841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Sandra Jumbe
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK
- Queen Mary University of London, London, UK
| | - Wai Y James
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK
| | | | - Liz Steed
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK
| | - Ratna Sohanpal
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Tammy K Yau
- Department of Medicine, California Northstate University, Elk Grove, California, USA
| | - Stephanie Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Chris Griffiths
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Robert Walton
- Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London, UK
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