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SMOKING CESSATION


the worst performer in the UK when it comes to smoking rates2


. Again, as


with other activities, there is a disparity between males and females of the species, with men being more likely to smoke than women in all locations.


You might assume that many of these smokers, both in the UK and Scotland more specifically, will be of older age categories, due to the historical belief (and advertising to the same effect) that smoking was a healthy past- time, which could improve respiratory health and overall vigour. However, the opposite is in fact true, with most smokers appearing to lie in the age grouping of 18-35 years (according to Cancer Research UK). Moreover, if we look more deeply at the numbers, we can also see that the total population of smokers in the UK has increased since 2010, suggesting that there is a real problem with current activities designed to assist patients to stop smoking.


What these figures also highlight is that delivering improved smoking cessation services is vitally important to the health of the country as a whole. These services, be they the simple education of smokers at an early stage, or the provision of a support service which can supply smokers with the pharmacological treatments they need to break their addiction, can all help to begin, facilitate and successfully complete the notoriously difficult process of giving up smoking. Thus, the role and placement of pharmacy, and particularly community pharmacy, within the patient care network is ideal for the delivery of these services. We pharmacists should thus act as the first port of call for those who wish to quit smoking, and also for those who may not have even entertained the thought of stopping yet. The ability of pharmacists to both identify and deftly communicate with those who may wish to stop smoking, in addition to the ability to provide important support as well as expertise about the wide range of therapies (including nicotine replacement therapy (NRT)) available, further cement the position of the pharmacist as one of the most critical players in the reduction in numbers of smokers in Scotland.


SMOKING CESSATION IN SCOTLAND


The provision of smoking cessation services by pharmacies in Scotland has been carried out for well over a decade, falling most recently under the Public Health Service component of the Community Pharmacy Contract. According to the contract, this service seeks to proactively seek out clients who may be suitable for the service, providing them with support and a means to obtain nicotine replacement therapies (NRT) for a course of around 12 weeks5


. Additionally, the service


offered by Scottish pharmacies offers a number of advantages of those offered in other UK countries, such as the ability for pharmacists to supply varenicline as part of the scheme, if deemed suitable. The ability to offer these services as part of a smoking cessation scheme should in theory offer an effective way to educate smokers and help them to quit. However, in recent times, the service has found itself in the firing line. The Pharmaceutical Journal has reported that the Scottish service is underutilised, partly due to a lack of referral to the service from other healthcare professionals, but more importantly, due to a lack of public knowledge of the service, with many users reporting that they “stumbled across” the programme by chance, or were informed about it by friends or family6


. It appears that a service


offering massive potential benefits to the Scottish National Health Service and also the health of Scotland itself may be getting lost in the noise of other pharmacy services, or may not be getting the promotion it deserves.


There may well be other reasons responsible for the lack of success of the smoking cessation service in Scotland, some of which are more liable for improvement than others. For example, reports have indicated that the presence of well-trained and committed staff is critical in the success of the program, providing service users with the correct advice, support and the confidence to fully quit. If such staff are absent, this may increase the failure rate of the programme. It also appears that the service may be more successful in


THESE SERVICES, BE THEY THE SIMPLE EDUCATION


OF SMOKERS AT AN EARLY STAGE, OR THE PROVISION OF A SUPPORT SERVICE WHICH CAN SUPPLY SMOKERS WITH THE PHARMACOLOGICAL TREATMENTS THEY NEED TO BREAK THEIR ADDICTION, CAN ALL HELP TO BEGIN, FACILITATE AND SUCCESSFULLY COMPLETE THE NOTORIOUSLY DIFFICULT PROCESS OF GIVING UP SMOKING


smaller pharmacies that are quieter, providing the pharmacist with the luxury of time, which they can use to carry out a comprehensive consultation with the service user. As such, not all aspects of service efficacy are under the control of the pharmacist. Moreover, the emergence of products such as e-cigarettes may be responsible for a lack of interest in a pharmacy-led service, despite the fact that these devices are currently unregulated, and may even undermine the patient’s wish to stop smoking7


.


It should be noted that feedback from pharmacists to the Scottish Government about the smoking cessation service has not fallen on deaf ears, with improvements such as the introduction of simplified record forms which are easier to use, and also an increase in advertising of the service leading to some improvements in both the running and outcomes of the service5


. Despite this, when the


recent smoking statistics are viewed, these actions still fall short of the mark, requiring Scottish pharmacists to go further to improve the health of their patients.


As a result of this, the Scottish


Government has recently made changes to its HEAT targets for smoking cessation, requiring that the NHS assisted a total of 12,000 people in the most deprived communities to quit by March 2015, leading to added pressures on pharmacies in these communities, particularly when other ongoing pharmacy roles are factored in. These targets have been subject to discussion between the NHS and pharmacy representatives, leading to the development of various strategies such as electronic recording of user data and quit information, taking the place of cumbersome paper-based records. These approaches, expected to be rolled out in the near future, in addition to the supply of carbon monoxide monitors to community pharmacies, are expected to assist pharmacists to deliver a more efficient and effective service, assisting those who want to quit the habit.


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. So, what can we do to


SCOTTISH PHARMACIST - 41


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