SMOKING CESSATION
SCRIPTED SMOKING CESSATION:
WHAT IS THE FUTURE OF THE SCRIPTED SMOKING CESSATION IN SCOTLAND?
By Kurtis Moffatt
Smoking remains the most important preventable factor for poor health in Scotland, contributing to an estimated 128,000 hospital admissions per annum, as well as 13,000 deaths and around £1.1 billion of costs to the Scottish economy. As pharmacists, we are ideally placed throughout the community to provide patients with accessible advice and support to address the issue of smoking and the related health risks. Thus it is important that patients who wish to quit smoking through their pharmacist, have available the best and most effective treatment in order to achieve and sustain abstinence. Stopping smoking is closely linked to a range of Scottish Government objectives to improve the health of the Scottish people
In 2014, 73,338 patients attempted to quit smoking with the help of NHS smoking cessation services in Scotland. While this was a marked reduction of 31 per cent on the previous year in 2013, it still encompassed an estimated seven per cent of the adult Scottish smoking population. More importantly, in 2014, of the 73,338 patients, 71 per cent made a supported quit attempt though a pharmacy service in Scotland. Despite the majority of attempts being made with a community pharmacist, quit rates obtained were relatively lower than that achieved through specialist (non-pharmacy) cessation services which offer more intensive behavioural support.
16 - SCOTTISH PHARMACIST
In order to provide community pharmacy smoking cessation services with the best tools available, a patient group direction (PGD) permitting pharmacists to provide their patients with varenicline (Champix®) was introduced in July 2014. The PGD was intended to eliminate the lengthy process of patients waiting to consult with a GP in order to obtain a prescription, then to have it dispensed at a local pharmacy and the later associated follow up reviews with their doctor. The intention behind this PGD was to reduce GP workload, lessen the patient journey and increase successful quit rates obtained through community pharmacy, as pharmacists are now capable of utilising the most effective drug therapy available. However, the scheme did not seem to produce the full benefi ts which were envisioned. The PGD was recently reviewed in July 2016, and, speaking to Andrew Radley (Consultant in Public Health Pharmacy NHS Tayside), it was clear that there was a number of reasons which may have led to the unpredictably slow and underwhelming uptake to the directive, despite its apparent benefi ts.
As pharmacists, we typically prescribe and advise within our own area of competency and prefer to use treatments that we are most familiar with. Varenicline was fi rst marketed in December 2006, and carried black triangle status because of a concern over neuropsychiatric side- effects. Use of the product therefore was with reluctance amongst some
pharmacists, who were much more familiar with nicotine replacement therapy (NRT) such as patches and inhalators and thus feel more confi dent to prescribe within this remit (being aware of their evidence based use and adverse effects).
However, following recent research conducted by the EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) clinical trial involving 8144 participants, it was established that varenicline carried no more signifi cant risk in developing neuropsychiatric events to that of bupropion, NRT or a placebo, but rather the main side effect documented for varenicline in the study was nausea, which occurred in 25 per cent (511 of 2016 treated with varenicline) patients. As a result of this trial, the black triangle status of varenicline has been removed as of May 2016 (Pfi zer); this deregulation should hopefully give pharmacists more confi dence in varenicline prescribing going forward.
Recent data has compared the cost- effectiveness and quit rate success of varenicline to that of NRT. Results from the ScotPHO 2014 report, show that 82 per cent of quit attempts involved the use of NRT. However, the use of a single NRT product to aid a quit attempt has decreased from 69 per cent to 35 per cent of quitters, while use of dual NRT (patch plus gum or inhalator) increased
from nine per cent to 47 per cent. Patients being prescribed just one product are less likely to be receiving the optimum dosage of therapy; however using more than one NRT product may be more expensive than use of varenicline. The ScotPHO report demonstrated that varenicline had the highest one-month quit rate (59 per cent), and, what’s more, the highest three-month quit rate (33 per cent) of those involved, proving a higher effi cacy than that of NRT in achieving abstinence.
Taking into account the fi ndings of these reports and concerns raised by pharmacists, Andrew Radley commented that the PGD has since been revised and simplifi ed from review conducted in July 2016. This will now hopefully see a much greater uptake by pharmacists, thus being able to provide a more cost-effective and effi cacious drug therapy to patients to aid quit smoking attempts in Scotland. With the majority of quit attempts occurring through a community pharmacy (71 per cent in 2014) the scope of this PGD is considerable. Through provision of varenicline and associated weekly support through the PGD, it should have a direct impact on patient benefi ts and a greater success in quit rates. •
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