SMOKING CESSATION


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


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. 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


42 - SCOTTISH PHARMACIST approach is adopted5 .


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 undertaking6


. 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 in a delicate way may just move the patient into that all- important “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. •


REFERENCES


1 World Health Organisation. Tobacco Factsheet. 2014; Available at: http:// www.who.int/mediacentre/factsheets/ fs339/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 Imelda Hametz, Fiona Hodgkiss, Christine Sheehy. Review of the Community Pharmacy Public Health Service for Smoking Cessation and Emergency Hormonal Contraception. 2011; Available at:


http://www.scotland.gov.uk/ Publications/2011/11/25084749/0. Accessed 13/10, 2014.


4 The Pharmaceutical Journal. Smoking cessation services underutilised in Scotland. 2011; Available at: http:// www.pharmaceutical-journal.com/ news-and-analysis/news/smoking- cessation-services-underutilised-in- scotland/11090417.article. Accessed 13/10, 2014.


5 Wang L. e-Cigarettes: should pharmacists be helping to turn smokers into “vapers”?. 2012; Available at: www.pharmaceutical-journal.com/ news-and-analysis/feature/e-cigarettes- should-pharmacists-be-helping-to-turn- smokers-into-vapers/11105264.article. Accessed 13/10, 2014.


6 NHS Scotland. A guide to smoking cessation in Scotland. 2014; Available at: http://www.healthscotland.com/ documents/4661.aspx. Accessed 13/10, 2014.


7 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;161:1409.


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