Promoting smoking cessation in pharmacy practice: Tips for busy pharmacists

Abstract

Community pharmacists are a largely untapped resource, with huge potential to promote smoking cessation because they interface with patients daily, according to Robin Corelli, PharmD, Professor of Clinical Pharmacy at the University of California, San Francisco (UCSF) School of Pharmacy. At APhA2015, she presented on tobacco cessation in pharmacy practice. Community pharmacists are a largely untapped resource, with huge potential to promote smoking cessation because they interface with patients daily, according to Robin Corelli, PharmD, Professor of Clinical Pharmacy at the University of California, San Francisco (UCSF) School of Pharmacy. At APhA2015, she presented on tobacco cessation in pharmacy practice. Pharmacists continue to be called upon to help promote smoking cessation. As part of its Tips From Former Smokers campaign, last year CDC created a page on its website with resources specifically for pharmacists, including information and promotional materials they can use to build awareness around smoking cessation. CDC relaunched the Tips campaign in late March 2015 with new advertisements, which still feature graphic images and stories from smokers who have suffered the consequences of smoking.Minimal timeWhile some pharmacists are now opting to be trained as certified tobacco treatment specialists who can deliver comprehensive counseling, including behavioral support, the truth is that most pharmacists have minimal time to provide counseling.“We know pharmacists are interested in this [smoking cessation] training, but the primary barrier is time,” said Corelli, who also teaches a smoking cessation training program at UCSF for pharmacists and other health care providers.Clinical practice guidelines for smoking cessation recommend the 5 As framework for cessation intervention: Ask, Advise, Assess, Assist, and Arrange.The Assist part, including assessing past quit attempts and discussing key issues associated with an individual’s tobacco use, can be time-consuming for pharmacists.Corelli said when time or logistics do not allow for comprehensive cessation counseling, pharmacists can apply an abbreviated 5As model whereby they Ask about tobacco use, Advise tobacco users to quit, and Refer patients willing to quit to existing resources and programs for further assistance.“There are a number of clinically significant drug interactions with tobacco smoke.”One of these resources is the national toll-free quitline: 800-QUIT-NOW for English speakers and 855-DÉJELO-YA for Spanish speakers.Besides the quitline, pharmacists should keep in mind that other resources, including Web- and community-based programs, are also available to support patients during a quit attempt.Documentation, workflowCorelli and other advocates of smoking cessation in pharmacy practice believe pharmacists should determine and document tobacco use status as a routine component of patient care.“There are a number of clinically significant drug interactions with tobacco smoke, and this is an important safety consideration when dispensing medications,” said Corelli.She said pharmacy technicians can play a key role by starting the conversation about quitting smoking with patients. “From a workflow perspective, it’s logical for technicians to ask about tobacco use when gathering patient information and to document smoking status in the pharmacy computer,” said Corelli.Technicians can also advise patients about the benefits of quitting and refer interested patients to the quitline or to the pharmacist for additional counseling, including the selection and proper use of smoking cessation medications.Pharmacological methodsHow does a pharmacist know what smoking cessation aid is best for each patient? Corelli said the best agent is the medication the patient will take correctly—which means making sure the patient can afford it, understands how to use it, and is willing to use it as prescribed.The most commonly used medications are nicotine replacement therapies (NRTs), including nicotine gum, patch, lozenge, nasal spray, and inhaler. Corelli said it’s important to keep in mind that when used alone, some NRT aids need to be taken frequently (e.g., every 1–2 hours while awake during the initial 4–6 weeks of treatment), and this might be difficult for some patients to adhere to. Other effective treatments include bupropion SR (Wellbutrin SR—GlaxoSmithKline) and varenicline (Chantix—Pfizer).Corelli is an advocate for combination therapy, whereby a patient uses a long-acting nicotine delivery system, such as the nicotine patch, in tandem with a short-acting nicotine formulation—the gum, lozenge, or inhaler—as needed throughout the day for situational cravings.She added that pharmacists should not recommend e-cigarettes as a firstline approach for smoking cessation. “It’s important for pharmacists to know that electronic nicotine delivery systems have not been established as safe or effective long-term for smoking cessation,” said Corelli. But it will be equally important for pharmacists to stay on top of research and information that will continue to surface about these products. Pharmacists continue to be called upon to help promote smoking cessation. As part of its Tips From Former Smokers campaign, last year CDC created a page on its website with resources specifically for pharmacists, including information and promotional materials they can use to build awareness around smoking cessation. CDC relaunched the Tips campaign in late March 2015 with new advertisements, which still feature graphic images and stories from smokers who have suffered the consequences of smoking. Minimal timeWhile some pharmacists are now opting to be trained as certified tobacco treatment specialists who can deliver comprehensive counseling, including behavioral support, the truth is that most pharmacists have minimal time to provide counseling.“We know pharmacists are interested in this [smoking cessation] training, but the primary barrier is time,” said Corelli, who also teaches a smoking cessation training program at UCSF for pharmacists and other health care providers.Clinical practice guidelines for smoking cessation recommend the 5 As framework for cessation intervention: Ask, Advise, Assess, Assist, and Arrange.The Assist part, including assessing past quit attempts and discussing key issues associated with an individual’s tobacco use, can be time-consuming for pharmacists.Corelli said when time or logistics do not allow for comprehensive cessation counseling, pharmacists can apply an abbreviated 5As model whereby they Ask about tobacco use, Advise tobacco users to quit, and Refer patients willing to quit to existing resources and programs for further assistance.“There are a number of clinically significant drug interactions with tobacco smoke.”One of these resources is the national toll-free quitline: 800-QUIT-NOW for English speakers and 855-DÉJELO-YA for Spanish speakers.Besides the quitline, pharmacists should keep in mind that other resources, including Web- and community-based programs, are also available to support patients during a quit attempt. While some pharmacists are now opting to be trained as certified tobacco treatment specialists who can deliver comprehensive counseling, including behavioral support, the truth is that most pharmacists have minimal time to provide counseling. “We know pharmacists are interested in this [smoking cessation] training, but the primary barrier is time,” said Corelli, who also teaches a smoking cessation training program at UCSF for pharmacists and other health care providers. Clinical practice guidelines for smoking cessation recommend the 5 As framework for cessation intervention: Ask, Advise, Assess, Assist, and Arrange. The Assist part, including assessing past quit attempts and discussing key issues associated with an individual’s tobacco use, can be time-consuming for pharmacists. Corelli said when time or logistics do not allow for comprehensive cessation counseling, pharmacists can apply an abbreviated 5As model whereby they Ask about tobacco use, Advise tobacco users to quit, and Refer patients willing to quit to existing resources and programs for further assistance.“There are a number of clinically significant drug interactions with tobacco smoke.” One of these resources is the national toll-free quitline: 800-QUIT-NOW for English speakers and 855-DÉJELO-YA for Spanish speakers. Besides the quitline, pharmacists should keep in mind that other resources, including Web- and community-based programs, are also available to support patients during a quit attempt. Documentation, workflowCorelli and other advocates of smoking cessation in pharmacy practice believe pharmacists should determine and document tobacco use status as a routine component of patient care.“There are a number of clinically significant drug interactions with tobacco smoke, and this is an important safety consideration when dispensing medications,” said Corelli.She said pharmacy technicians can play a key role by starting the conversation about quitting smoking with patients. “From a workflow perspective, it’s logical for technicians to ask about tobacco use when gathering patient information and to document smoking status in the pharmacy computer,” said Corelli.Technicians can also advise patients about the benefits of quitting and refer interested patients to the quitline or to the pharmacist for additional counseling, including the selection and proper use of smoking cessation medications. Corelli and other advocates of smoking cessation in pharmacy practice believe pharmacists should determine and document tobacco use status as a routine component of patient care. “There are a number of clinically significant drug interactions with tobacco smoke, and this is an important safety consideration when dispensing medications,” said Corelli. She said pharmacy technicians can play a key role by starting the conversation about quitting smoking with patients. “From a workflow perspective, it’s logical for technicians to ask about tobacco use when gathering patient information and to document smoking status in the pharmacy computer,” said Corelli. Technicians can also advise patients about the benefits of quitting and refer interested patients to the quitline or to the pharmacist for additional counseling, including the selection and proper use of smoking cessation medications. Pharmacological methodsHow does a pharmacist know what smoking cessation aid is best for each patient? Corelli said the best agent is the medication the patient will take correctly—which means making sure the patient can afford it, understands how to use it, and is willing to use it as prescribed.The most commonly used medications are nicotine replacement therapies (NRTs), including nicotine gum, patch, lozenge, nasal spray, and inhaler. Corelli said it’s important to keep in mind that when used alone, some NRT aids need to be taken frequently (e.g., every 1–2 hours while awake during the initial 4–6 weeks of treatment), and this might be difficult for some patients to adhere to. Other effective treatments include bupropion SR (Wellbutrin SR—GlaxoSmithKline) and varenicline (Chantix—Pfizer).Corelli is an advocate for combination therapy, whereby a patient uses a long-acting nicotine delivery system, such as the nicotine patch, in tandem with a short-acting nicotine formulation—the gum, lozenge, or inhaler—as needed throughout the day for situational cravings.She added that pharmacists should not recommend e-cigarettes as a firstline approach for smoking cessation. “It’s important for pharmacists to know that electronic nicotine delivery systems have not been established as safe or effective long-term for smoking cessation,” said Corelli. But it will be equally important for pharmacists to stay on top of research and information that will continue to surface about these products. How does a pharmacist know what smoking cessation aid is best for each patient? Corelli said the best agent is the medication the patient will take correctly—which means making sure the patient can afford it, understands how to use it, and is willing to use it as prescribed. The most commonly used medications are nicotine replacement therapies (NRTs), including nicotine gum, patch, lozenge, nasal spray, and inhaler. Corelli said it’s important to keep in mind that when used alone, some NRT aids need to be taken frequently (e.g., every 1–2 hours while awake during the initial 4–6 weeks of treatment), and this might be difficult for some patients to adhere to. Other effective treatments include bupropion SR (Wellbutrin SR—GlaxoSmithKline) and varenicline (Chantix—Pfizer). Corelli is an advocate for combination therapy, whereby a patient uses a long-acting nicotine delivery system, such as the nicotine patch, in tandem with a short-acting nicotine formulation—the gum, lozenge, or inhaler—as needed throughout the day for situational cravings. She added that pharmacists should not recommend e-cigarettes as a firstline approach for smoking cessation. “It’s important for pharmacists to know that electronic nicotine delivery systems have not been established as safe or effective long-term for smoking cessation,” said Corelli. But it will be equally important for pharmacists to stay on top of research and information that will continue to surface about these products.