REPORT
CORE SMOKING CESSATION SERVICE WITHIN SCOTLAND:
WHAT IS THE CURRENT SITUATION AND WHAT ARE WE
DOING ABOUT IT? As smoking continues to be one of the main contributors to major health complications in Scotland, with a market of products that continues to grow, and advice available at our fi ngertips, do patients still look to their community pharmacists for the most up-to-date and reliable advice on how to quit?
Cigarette smoking still remains the single largest cause of preventable illness and early death in the United Kingdom (UK), leading to approximately 102,000 related deaths and ailments annually, which, consequently, have a direct impact on other vital health care services costing an estimated £5.2 billion to the NHS annually.
The eradication of smoking from the UK would result in vast health benefi ts, particularly for the most deprived sectors of society, and, while the prevalence of smoking has substantially fallen in the UK since fi rst publication of the health risks associated with smoking, it now appears to be stabilising at approximately one in fi ve adults. Indeed, the Scottish Government has published a smoking strategy that calls for the creation of a Scotland where almost nobody smokes. The achievement of this policy outcome is defi ned as 2034.
Despite awareness of the health implications of smoking continually in the public eye, and a surplus of alternative options to aid in an attempt to quit at our disposal - including Nicotine Replacement Therapy (NRT) and Varenicline - we need to look at why participation rates are gradually decreasing within the core smoking cessation service in Scotland, and consider what we can do to reverse this decline. Therefore, we need to ask ourselves - as pharmacists, what are we doing to
20 - SCOTTISH PHARMACIST
address and combat this ever growing issue?
The aim of the core service is to deliver a pharmacy-based, one-stop specialist smoking cessation service to smokers, which is evaluated and monitored in line with the Scottish Government’s Local Delivery Plan targets. The Public Health Service that’s offered by community pharmacy offers smokers a twelve- week programme of behavioural support and permits the weekly supply of NRT if required. NRT and Champix are manageable and effective pharmacological aids to stopping smoking and have been an integral part of pharmacy smoking cessation services for many year.
Evidence has also shown that the combination of high quality behavioural support and counselling, along with the supply of NRT, can increase a smoker’s chance of quitting up to four fold compared to quitting alone.
According to the latest fi gures released by Information Services Division (ISD) Scotland in its report ‘NHS Smoking Cessation Services (Scotland) 1 April to
31 March 2016’, which was published in October, the number of quit attempts made with the help of NHS smoking cessation services fell for the fourth consecutive year to 64,736. This represents a fi ve per cent year-on-year decrease from 2014/15 compared to a 28 per cent year-on-year fall between 2013/14 and 2014/15.
The rise in the use of electronic cigarettes to help quitting may have contributed to these changes. Of the estimated 932,000 adult smokers in Scotland an estimated seven per cent made a quit attempt with an NHS smoking cessation service. There were 2,291 quit attempts made by pregnant women, a 19 per cent decrease since 2014/15.
NHSScotland met its smoking cessation standard, with nine of the fourteen NHS Boards meeting their individual standards. One month after quit dates, 37 per cent (23,990) reported that they were still not smoking. This fi gure fell to 22 per cent (13,965) by three months. Of the 23,990 self-reported one month quits, 65 per cent (15,685) were confi rmed on carbon monoxide (CO) testing,
implying a true quit rate of 24 per cent.
Although only 30 per cent of quit attempts were supported by specialist services (non-pharmacy), there were much higher quit rates (48 per cent and 33 per cent at one and three months compared to 33 per cent and 17 per cent for pharmacy services). There were higher quit rates at both one and three months for treatment with Varenicline compared with NRT.
Pharmacy smoking cessation services accounted for 45,635 (70 per cent) of quit attempts made in Scotland in 2015/16. The split of pharmacy and non-pharmacy services to support quit attempts varied among NHS Boards from fi fteen per cent and 85 per cent respectively in NHS Western Isles to 96 per cent and four per cent respectively in NHS Tayside (fi gure 20). Of 13,965 three month quits in 2015/16 in Scotland, 55 per cent were made in pharmacy services, and 45 per cent in non-pharmacy services. Although pharmacies see a larger number of clients, they have relatively lower percentage quit rates than specialist
DISTRIBUTION OF QUIT ATTEMPTS VIA PHARMACY / NON-PHARMACY: NHS BOARDS; 2015/16
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ISD Scotland
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