Stop smoking document offers practice points for pharmacists
A document offering detailed advice on how pharmacists can help smokers to stop has been produced jointly by the Royal Electronicjuice, PharmacyHealthLink and the Health Development Agency (now incorporated into the National Institute for Health and Clinical Excellence).
Written by Hayden McRobbie and Andy McEwen, the 28-page document, “”, covers the role of pharmacists in helping smokers to stop and aims to give pharmacists the basic information they need to help smokers to stop. Although it has been produced primarily for pharmacists in England, the document makes it clear that the advice provided should be equally applicable to pharmacists in other parts of the UK.
An introduction to the document says that the contribution pharmacists can make to improving the health of the population has been recognised by the NHS and is reflected in the new contractual framework for community pharmacy, which is in an ideal position to offer both preventive advice and treatment. Hospital pharmacists, too, are ideally positioned to provide brief smoking cessation advice, as are pharmacists in other areas where they come into direct with the public, such as in GP surgeries, care homes and private health care facilities.
The bulk of the document is divided into two sections — “Helping smokers to stop” and “Useful information”.
Section 1, “Helping smokers to stop”, begins by providing information on aspects of nicotine addiction, including a table setting out the average duration of the various tobacco withdrawal symptoms.
Section 1 says that smoking cessation guidelines recommend that all health professionals check on the smoking status of their patients or clients at least once a year and offer opportunistic advice to the smokers about quitting.
The document goes on to say that many smoking cessation services in the NHS use withdrawal-oriented therapy that focuses on preventing relapse in the early stages of a quit attempt, by giving intensive support when withdrawal symptoms are at their worst, closely supervising medicine use and emphasising the importance of complete abstinence. It says that community pharmacists can deliver treatment on a part-time or sessional basis, providing an alternative to group treatment in clinics. They need at least two days’ training, covering smoking demographics, the health risks of smoking, the benefits of stopping, smoking cessation treatments and their outcomes, assessment, pharmacotherapy, the delivery of behavioural support, and monitoring treatment.
The document includes a three-page aide-mémoire to assist pharmacists already involved in providing smoking cessation treatments.
Section 1 concludes with information about the only evidence-based pharmacotherapies available in the UK — nicotine replacement therapy and bupropion. It gives brief information on the rationale for using NRT, the evidence for its effectiveness and the range of NRT formulations. It discusses long-term use of NRT, the use of combinations of NRT products and safety issues. It also discusses the evidence for the use of bupropion as a safe and effective treatment. It explains where to find a template patient group direction that can be used to allow pharmacists to supply this prescription only medicine.
Section 2, “Useful information”, provides data on smoking patterns and prevalence, health risks, the benefits of stopping smoking and why cutting down does not work. It also gives details of a range of internet resources, including six stop smoking websites, an extensive bibliography.
Robert Clayton, the Society’s lead for long-term conditions and public health, said: “Many pharmacists are already actively involved in the NHS stop smoking service and offer comprehensive and flexible treatment. However, the opportunity exists for many more pharmacists to take an active role in both prevention and treatment of smoking.”
The document is available through the of the NICE website. It can also be reached by a link from the of the Society’s website. A hard-copy version and further information can be obtained from the Directorate Administrator, Practice and Quality Improvement Directorate, Royal Electronicjuice, 1 Lambeth High Street, London SE1 7NJ (tel 020 7572 2208; e-mail [email protected]).