FEATURE


In terms of this decrease, there are a number of variables which may be responsible – lack of referral by other healthcare professionals, lack of public knowledge about the service, the absence of well trained and committed staff, and the introduction of products such as electronic cigarettes have all been implicated in the reduction in these numbers, however this list isn’t exhaustive.


Regardless of the causes, it’s clear that more needs to be done in order to encourage smokers to make use of the service, and as pharmacists are clearly the leading providers of this service, we’re in the best position to take charge of this increased drive forward.


Smoke signals – improving the success of smoking cessation As mentioned already, there is no argument that the pharmacy profession is the leader when it comes to the delivery of smoking cessation support – in fact, around 70% of quit dates in each of N. Ireland’s health board areas were set at a community pharmacy in the last year. So, what can we do to build on this and further improve our successes?


As always, there isn’t a panacea for this problem, and improvement of the outcomes will be particularly multifactorial.


One suggestion however, is to ensure that the service is fully utilised in an appropriate way for each patient, with their care being as tailored as possible.


• A minimum of 6 months must lapse before a client who has previously participated in a specialist smoking cessation programme can be reregistered with a smoking cessation service.


Pharmacists will be aware of many of these quality standards, if not all of them, but are encouraged to keep their knowledge up to date so that they can continue to ensure that they are delivering the service in its most modern guise.


So, how much of a difference are Northern Ireland’s smoking cessation services making in reality? In the most recent data available (2013-2014), the statistics look promising, with the report from the DHSSPSNI including the following(4)


:


• At the 4-week follow-up 15,813 reported that they had successfully quit, 59% of those setting a quit date.


• The 4-week success rate was 60% for males and 58% for females. Success at 4 weeks increased with age, from 43% for the under 18s to 64% for those aged 60 and over


• Of the 1,557 women who were recorded as being pregnant, 60% reported to have successfully quit at the 4-week follow-up


Whilst all of this data, and other statistics, are indeed promising (the rest can be found in the DHSSPS document, “Statistics on Smoking Cessation Services in Northern Ireland: 2013/14”, see references at the end of this article), it’s also important to make note of the statistics which aren’t quite as good.


One of the main negative points held within this latest data is that there has been an 18% decrease in the numbers of patients setting a quit date, in comparision to the previous year, equivalent to a decrease of 5,844 patients.


This is obviously a cause for concern (particularly as we know that the total number of smokers is on the up!), and one which needs to be addressed in order to make the service more successful, and ultimately lead to a more significant reduction in the numbers of smokers within out communities.


For example, the use of NRT within a patient’s management has been shown by the NHS in Scotland to lead to improved outcomes, with abstinence from tobacco being increased by 5-8% in those who were provided with NRT in comparison with those who were provided with behavioural support alone.


Further to this, the use of combination therapies (i.e. the provision of a NRT therapy to provide a “baseline” nicotine level, in addition to a further product to control cravings which occur during the course of the day), rather than unitherapies, can further improve outcomes, with 6 month quit rates being increased by up to 6% if this approach is adopted(5).


In addition to these pharmacological strategies, pharmacists should also be fully aware of the psychological nature of addiction, as the understanding of this phenomenon is critical to being able to assist a patient with their quit process.


In short, this includes being aware of the cycle of change (which consists of five main steps: pre-contemplation, contemplation, ready-for-action, action, maintenance, and may also include a relapse into any of the stages) and how the patient should be managed during each stage to


facilitate the success of their undertaking(6)


.


There are many resources open to pharmacists which can assist with their understanding of these behaviours, and their appropriate management, and all pharmacists should be encouraged to have a strong knowledge in these areas.


In addition, improved patient knowledge of the service is critical to its success – this can involve straightforward advertising, speaking to patients, or more novel partnerships with other healthcare providers.


In addition, pharmacists should try to actively identify patients who may benefit from the smoking cessation service.


This could be during the dispensing of prescriptions, or even during over the counter consultations – asking the patient if they smoke during your questioning, and using an affirmative answer as a trigger to make them aware of the service may just move the patient into that “contemplation” phase!


Fighting fires Overall, smoking cessation services, in particular those offered by community pharmacies, offer a huge benefit, which has the potential to be even more expansive.


Due to the nature of a pharmacist’s skills, we are at the forefront of promotion and delivery of this service, and we should ensure that we use our skills in an even more proactive way to both increase the numbers of smokers that we can help, and also to improve those all important quit rates! Doing so can have no other effect but to improve the health of our population. n


References (1) World Health Organisation. Tobacco


Factsheet. 2014; Available at: http://www.who.int/mediacentre/factsheets/fs33 9/en/. Accessed 13/10, 2014. (2) Cancer Research UK. Tobacco statistics. 2014; Available at: http://www.cancerresearchuk.org/cancer- info/cancerstats/causes/tobacco-statistics/#By. Accessed 13/10, 2014. (3) DHSSPSNI. Regional Pharmacy Specialist Smoking Cessation Service - A Pharmacist's Guide. 2015; Available at: http://www.hscbusiness.hscni.net/pdf/Pharmacis ts_Guide_.pdf. Accessed 10/13, 2015. (4) DHSSPSNI. Statistics on Smoking Cessation Services in Northern Ireland: 2013/14. 2014; Available at: http://www.dhsspsni.gov.uk/smoking-cessation- 2013-14.pdf. Accessed 10/13, 2015. (5) NHS Scotland. A guide to smoking cessation in Scotland<br />. 2014; Available at: http://www.healthscotland.com/documents/466 1.aspx. Accessed 13/10, 2014. (6) Gretchen L. Zimmerman, Psy.D., Cynthia G. Olsen, M.D., And Michael F. Bosworth, D.O.,. A ‘Stages of Change’ Approach to Helping Patients Change Behavior. Am Fam Physician 2000;1(61):1409.


pharmacyinfocus.co.uk 53


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64