SMOKING “whEN It cOmES tO hEalth
PROmOtION, NO OPPORtUNIty tO INfORm PatIENtS aBOUt thE SERVIcE OR thE hEalth BENEfItS Of QUIttINg SmOkINg ShOUld BE mISSEd”
campaigns, eg, No Smoking day (colin organised a large non-smoking event at national No Smoking day 2016 which the local mlas attended, extending the service to a wider audience)
colin participates in the Building the community-Pharmacy Partnership (BcPP) which involves young men with mental health issues and also uses this to highlight and address the health implications of smoking.
> collaborative with other healthcare professionals in order to move
towards a liaised service with gPs and hospitals. this can be achieved by referrals from gPs or hospitals directly into the pharmacy service, with allocated time set aside in order to run and manager a smoking cessation clinic. Pathways are needed to be tailored and developed as part of transforming your care (tyc) to include referral into the stop smoking service.
'the time period for a patient who initially fails to quit when reapplying to the scheme could be reviewed in order to maximise participation and eventual success rates, as approximately two thirds of current smokers say they want to quit. however, as nicotine is a highly addictive substance, the desire to quit is very often not enough, and the majority of smokers will attempt to break the addiction several times before achieving their aim, and therefore should be permitted to try again if they feel confident to do so without waiting a period of six months.'
the potential for helping smokers in primary care is enormous, with Uk community pharmacists coming into contact with six million people each day.
colin harrison, owner of harrison healthcare in Belfast, and his clinical pharmacist, andrew cheung, are currently endeavouring to put the pharmacy at the forefront of the service itself. Both pharmacists conduct work within the pharmacy during normal opening hours but also outside of this timeframe venturing into the community in order to increase awareness and participation in the service via various outlets.
22 - PhaRmacy IN fOcUS
'I think one of the most significant changes we have made that had a positive impact was setting up a smoking cessation clinic on wednesday mornings within the pharmacy, with set times to manage and run this service effectively,' andrew said. 'during this protected time, it is much easier to build a rapport, and to give patients the time that they require and understand the reasons behind wanting to quit in order to provide reinforcement and tailoring advice for these. It is essential to ensure that patients have a genuine want to quit, and therefore, like most pharmacies, it is important to not sign anyone up on the first consultation but rather give patients a time and date on which to call back: generally a period of one week to guarantee they are serious about their quit attempt.'
'when it comes to health promotion,' colin said, 'no opportunity to inform patients about the service or the health benefits of quitting smoking should be missed, whether this presents itself in the pharmacy or through his other work in the community.'
colin listed various situations which he uses in order to highlight this to patients including: • when dispensing prescriptions for respiratory disease, cardiovascular disease or to pregnant women • when providing minor ailment advice, or over the counter queries, eg, for coughs, cold remedies and NRt • other services such as medicines use reviews, medicines management or flu, either within the pharmacy or at local businesses • to make use of key dates in the calendar such as New year’s (resolutions) • involvement in local and national
One issue that was raised by colin, andrew and james, was the obvious growing use of electronic cigarettes or 'e-cigs', and the direct impact this has had, not only on the decline in patient participation in the smoking cessation service, but also on the change in mindset they have caused in what is actually defined as 'quitting smoking'. E-cigs have been on the market in the United States since 2008 and, in recent years, filtered their way onto the Uk market. Now, evidence is beginning to emerge on both e-cigs' short-term effects, and their positive and negative impact on people's health.
E-cigs are battery-powered devices that heat a liquid usually containing nicotine mixed with chemicals including propylene glycol and glycerine (and often flavourings) into a vapour that users can inhale. as they deliver nicotine to the body by creating a vapour - as opposed to smoke - and generally deliver less nicotine than cigarettes do.
however, this doesn't mean the devices always embody a safer alternative to cigarettes. In fact, one of the most dangerous things about e-cigs is that they may keep people smoking conventional cigarettes longer, rather than encourage them to attempt to quit. But, regardless of how the nicotine is delivered - whether through e-cigs or conventional cigarettes - it still has an effect on the body. the drug is a cardiovascular stimulant, and can potentially worsen heart disease in people who already have severe heart conditions.
though it's not known whether nicotine alone can cause heart disease in people who don't have heart problems, some research has shown it may cause damage to arteries. Nicotine also has effects on reproductive health and exposure during pregnancy may lead to low
birth weights regardless of delivery method, and therefore is it not advisable to recommend as a safe alternative during pregnancy.
But all in all, even if e-cigarettes involve some health risks, they are not more toxic than cigarettes, and so moving away from tobacco is a move in the right direction. Eventually, the goal is to get people off vaping and to quit completely, but people have to start somewhere. One possible explanation is that people may generally use e-cigs as part of a 'taper-down' strategy, which is less effective than quitting cold turkey.
colin harrison believes that this strategy should be implemented by all pharmacists involved in the service. 'Instead of not including patients who have chosen to vape in the smoking cessation programme,' he continued, 'we need to incorporate this taper- down strategy into our advice with individual patients rather than turn them away from the service because of this.
'It is also imperative to make patients aware that, while they may believe it a safer alternative to vape rather than smoke cigarettes, there is currently no tangible evidence in support of this. NRt, on the other hand, which is available on the service, has been tried and tested and should be the first line in terms of pharmacological aid (if needed) in support of a quit attempt alongside lifestyle advice in a supported reduction.'
the future of smoking cessation and the service itself is uncertain, as the market continues to grow with more diverse products reaching patients and advice (whether supported by evidence or not) available at the click of a button it is hard to know that participation will rise within the service as we hope.
certainly moving towards a more collaborative service with other healthcare professionals is a start, and, where possible, allocated time to manage this would deliver better results. One thing that we cannot underestimate is not only the potential of the service itself to make a difference to a smoker’s health, but also the potential of the pharmacist as the expert on the high street to make an impact through our knowledge, expertise and skills on our patients. •
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