Pharmacy Support Research Articles

Improving medication reconciliation in ambulatory cancer care.

224 Background: Adverse drug events are common in ambulatory oncology where care spans multiple providers and medication documentation is often poor. We undertook a QI project with the aim of having 30% of patients have a best possible medication history (BPMH) or medication reconciliation (MedRec) documented within 30 days of starting systemic therapy. Methods: An Electronic Medical record-Integrated Tool (EMITT) was developed to facilitate documentation. 2 Plan-Do-Study-Act (PDSA) cycles have been completed to date; PDSA 1 consisted of piloting EMITT in 3 clinics run by physician champions. PDSA 2 which consisted of expanding pharmacy support and addition of a 4th clinic was impacted by care changes related to COVID. The proportion of patients with BPMH/MedRec documented in EMITT was calculated monthly for each period (PDSA 1, PDSA 2 pre-COVID and PDSA 2 post-COVID). The balancing measure of time to complete an entry was evaluated through a time motion study. Results: Between 9/9/2019 and 31/5/2020, 9.4% (233/2488) of patients had BPMH/MedRec completed; Table shows proportion of patients by month. BPMH and MedRec were most frequently performed by pharmacists followed by pharmacy students and nurses. On average, it took 5.5 minutes to complete an entry (n = 10; median number of medications per patient = 12.3). Conclusions: BPMH was documented more often than MedRec. While some usage was sustained, the changes to care as a result of COVID-19 negatively impacted ambulatory medication reconciliation. Future PDSA cycles will involve engaging patients in MedRec and extending EMITT to all ambulatory cancer clinics where medication management is a major component of care. [Table: see text]

A programme to treat chronic hepatitis B in Kiribati: progress and challenges.

ProblemOver 290 million people worldwide suffer from chronic hepatitis B (CHB), with the highest prevalence in the Pacific islands. Mortality attributable to this disease exceeds that from HIV, tuberculosis and malaria combined in this region.ContextCHB is a major health problem in the Pacific island nation of Kiribati. Medical care is complicated by vast expanses of ocean separating population centres in its constituent islands. Birth-dose hepatitis B immunization rates need improvement. High rates of obesity, metabolic syndrome, and co-infection with hepatitis B and hepatitis D in Kiribati make treatment less effective. Staff allocation, training and retention are difficult. Limited infrastructure creates challenges in training, communications, laboratory testing and record-keeping.ActionWe have established a CHB treatment programme in Kiribati based on World Health Organization (WHO) guidelines and local needs. It includes direct patient care; laboratory, radiology and pharmacy support; public education; training; and data management. Thousands of individuals have been screened, and 845 hepatitis B-positive patients have had blood sent to Australia for molecular testing. Patient education pamphlets, medical training programmes and treatment protocols have been developed. Seventy-nine patients have started treatment. Regular onsite visits by technical experts are scheduled throughout the year.Lessons learnt and discussionThis is the first national CHB treatment programme established in the Pacific islands region. Unique challenges exist in Kiribati, as they do in each nation affected by CHB. Close engagement with local partners, knowledge of the barriers involved, flexibility, advocacy, and support from WHO and volunteer technical experts are key attributes of a successful treatment programme.

In-hospital System Construction and Insurance Pharmacy Support at the Time of Introducing Telephone Re-examination in the Amami Archipelago

In-hospital System Construction and Insurance Pharmacy Support at the Time of Introducing Telephone Re-examination in the Amami Archipelago

P14 Reducing medication errors using prescribing nudges: intravenous aciclovir on paediatric intensive care

AimThis Quality Improvement project is the second phase of a long term project to improve the quality of prescribing on the paediatric intensive care unit (PICU). Small adjustments are made to the electronic prescribing (EP) system, known as ‘nudges’, with the aim of improving the quality of prescribing in terms of error rate or user experience.1 2Intravenous aciclovir is prescribed to most patients admitted to the PICU with suspected meningitis/encephalitis. There is a complicated dosing schedule where the prescriber must decide whether to use body surface area (BSA) or weight to calculate the required dose. Underdosing risks subtherapeutic treatment of a viral encephalitis and overdosing risks acute kidney injury. Within our EP system, dosing by weight can be automated, but dosing by BSA cannot.A project in 2018 used a ‘nudge’ to alter the order of prescribing options in the drop down menu on the EP system. This reduced the error rate from 26% to 17% by reducing the likelihood of picking the wrong indication for acyclovir.3 However, a re-audit in October to December 2018 found the error rate had crept back up to 32%. Prescribing on the EP system is a multi-step process. Prescribers had to pick ‘aciclovir’ to choose the weight based dose or ‘aciclovir injection 3 month-11 yr‘ to choose the BSA based dosing. When ‘aciclovir’ was picked, this removed the body surface area dosing option from the prescriber’s screen and led them in the direction of an incorrect dose.MethodThe intervention for this project was to amalgamate all weight and BSA dosing options for acyclovir within the EP system, and then order them by age so that the prescriber could see all options simultaneously. This change was designed and implemented by our electronic prescribing support pharmacist in April 2019. Pre and post change prescriptions were audited by pharmacy undergraduate students for accuracy using data downloaded from the EP system.ResultsThe error rate post change was 8% (pre change 32%). The remaining errors reflect transcribing of an incorrect dose initiated outside of the PICU from a referring ward or hospital.ConclusionThis project shows that small, ‘smart’ changes within EP configuration can improve the quality of prescribing.Future work involves working with the software company to incorporate the ability to automatically calculate the dose based on BSA, further reducing the need for manual calculations. This project would not have been possible without the skills and knowledge of our electronic prescribing support pharmacy team.ReferencesPatel MS, et al. Nudge units to improve the delivery of health care. NEJM 2018; 378: 214–216Cafazzo JA, et al. From discovery to design: the evolution of human factors in healthcare. healthcare quarterly 2012; 15: 24–29Gunning C, Gray J. Audit of acyclovir prescribing to assess whether changing the order of drop down box options in an electronic prescribing system can reduce prescribing errors. Archives of Disease in Childhood 2019; 104:7

Views and experiences of community pharmacy team members on antimicrobial stewardship activities in Scotland: a qualitative study

Background It has been acknowledged and recognised internationally that the community pharmacy team has a major role to play in antimicrobial stewardship programmes, particularly regarding patient engagement. However, there is a paucity of published research on community pharmacy-based activities in antimicrobial stewardship, and views and perceptions of the community pharmacy team on their role in antimicrobial stewardship. Objective To explore views and experiences of community pharmacy teams across Scotland on antimicrobial stewardship, activities related to European Antibiotic Awareness Day, and a self-help guide to treating infection. Setting Community pharmacy, Scotland. Methods Qualitative, semi-structured in-depth telephone interviews were undertaken with a purposive sample of community pharmacy team members over a six week period between November and December in 2016. Interviews were audio-recorded, transcribed verbatim and data analysed thematically using the framework approach. Main outcome measure Views and perceptions of antimicrobial stewardship and European Antibiotic Awareness Day activities and role of the pharmacy team. Results Twenty-seven participants were interviewed—20 pharmacists, five pharmacy graduates completing their pre-registration year, and members of the pharmacy support team including two pharmacy technicians and one medicines counter assistant. They were working mainly in urban areas and across five regions of Scotland. Most were aware of antimicrobial stewardship but some were not familiar with the term. Participants identified roles for the community pharmacy team in antimicrobial stewardship including the importance of the pharmacy as a first port of call for self-care advice. Some participants, including pharmacists, showed lack of awareness of European Antibiotic Awareness Day; those who were aware thought it may not have the desired impact on educating the public. Most participants, irrespective of role within the team, were not familiar with the self-help guide but they perceived this as a useful resource for the pharmacy team. Conclusion The participants recognised and identified roles for the community pharmacist within antimicrobial stewardship. However, the lack of awareness of European Antibiotic Awareness Day shows a need for European Antibiotic Awareness Day tools and other materials to be more effectively disseminated and for more training to be provided.

Considerations for development of pharmacy support models for COVID-19 alternate care sites.

PurposeGuidance on alternate care site planning based on the experience of a health-system pharmacy department in preparing for an expected surge in coronavirus disease 2019 (COVID-19) cases is provided.SummaryIn disaster response situations such as the COVID-19 pandemic, healthcare institutions may be compelled to transition to a contingency care model in which staffing and supply levels are no longer consistent with daily practice norms and, while usual patient care practices are maintained, establishment of alternate care sites (eg, a convention center) may be necessitated by high patient volumes. Available resources to assist hospitals and health systems in alternate care site planning include online guidance posted within the COVID-19 resources section of the US Army Corps of Engineers website, which provides recommended medication and supply lists; and the Federal Healthcare Resilience Task Force’s alternate care site toolkit, a comprehensive resource for all aspects of alternate care site planning, including pharmacy services. Important pharmacy planning issues include security and storage of drugs, state board of pharmacy and Drug Enforcement Administration licensing considerations, and staff credentialing, education, and training. Key medication management issues to be addressed in alternate site care planning include logistical challenges of supply chain maintenance, optimal workflow for compounded sterile preparations (eg, on-site preparation vs off-site preparation and delivery from a nearby hospital), and infusion pump availability and suitability to patient acuity levels.ConclusionPlanning for and operation of alternate care sites in disaster response situations should include involvement of pharmacists in key decision-making processes at the earliest planning stages.

Significant Published Articles for Pharmacy Nutrition Support Practice in 2019

The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2019 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included. Results: A total of 111 articles were identified; 6 from the primary literature were voted by the group to be of high importance. An additional 9 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.

Evaluation of a Pharmacist-Driven Procalcitonin Protocol for Lower Respiratory Tract Infections Using a Clinical Decision Support System.

Purpose: Procalcitonin (PCT) may be an effective biomarker in the management of lower respiratory tract infections (LRTI) when combined with antimicrobial stewardship support. We assessed the impact of a PCT protocol with clinical pharmacy support for LRTI using a clinical decision support system (CDSS) for monitoring. Methods: This was a single-center retrospective cohort study conducted at a large, nonteaching hospital in Nashville, TN. All patients who met eligibility requirements and were initiated on the PCT protocol for a suspected LRTI between February and March 2018 were included and matched to historical control patients from 2016 to 2017 on a 1:1 basis based on antibiotics, indication, and time of year. Results: During this 2-month period, a total of 126 patients met eligibility requirements for inclusion in the PCT group and were matched to historical control patients. Patients in the PCT group received decreased median antibiotic days of therapy (DOT) compared to controls (11 vs 14, P = .004). There was no change in median length of stay (LOS) between groups. The acceptance rate for patient-specific antibiotic de-escalation recommendations from the clinical pharmacist was 62.5%. Conclusion: PCT protocols that utilize clinical pharmacist interpretation and a CDSS may be an effective intervention of the antimicrobial stewardship program (ASP) for decreasing antibiotic DOT for LRTI.

Abstracts of the 29th Annual Pediatric Pharmacy Association (PPA) Meeting April 29 to May 3, 2020

Abstracts of the 29th Annual Pediatric Pharmacy Association (PPA) Meeting April 29 to May 3, 2020

Community pharmacy staff oral health training, training needs and professional self-efficacy related to managing children's dental problems.

Few studies have explored the oral health training needs and professional self-efficacy (PSE) in both pharmacy support staff and pharmacists related to managing children's dental problems. This study assessed community pharmacy staff perceptions of their (i) training experiences and interests; (ii) PSE; and (iii) whether this was influenced by the pharmacy being part of a minor ailment scheme (MAS), where staff could directly offer advice and issue prescription medications without patients seeing a doctor. All of the 1851 community pharmacies across London, UK, were invited to participate in an online questionnaire. Staff rated their prior training, perceived need for further training and confidence in giving parents advice related to three dental problems in children (dental pain, mouth ulcers and dental trauma). Information was collected about staff roles and whether the pharmacy was a MAS. From 752 community pharmacies, 846 community pharmacy staff participated. Positive experiences of training were variable but interest in further training for all three dental problems was high. Pharmacy support staff had significantly lower PSE scores than pharmacy professionals (P=0.009). A significant interaction showed that pharmacy staff who had poorly rated prior training on advising parents about managing their child's dental pain and who did not work in a MAS had lower PSE scores than staff who had highly rated training and who worked in a MAS (P=0.02). Minor ailment scheme pharmacies may be an optimal environment for frontline pharmacy support staff to develop higher PSE when combined with good quality oral health training.

A Qualitative Exploration to Understand Access to Pharmacy Medication Reviews: Views from Marginalized Patient Groups.

Background: Vulnerable patients from marginalized groups (e.g., people with disabilities, people experiencing homelessness, black and minority ethnic communities) experience higher rates of ill-health, inequitable access to healthcare and low engagement with screening services. Addressing these disparities and ensuring healthcare provision is impartial and fair is a priority for the United Kingdom (UK) healthcare system. Aim: Using Levesque’s access conceptual framework, this study explored the views of patients from marginalized groups, specifically on how access to pharmacy services could be improved and their experiences of receiving a medication review service. Method: Qualitative data were collected via semi-structured interviews on patient experiences of pharmacy services and how access to these could be improved (n = 10). Interviews of patients who had received a medication review from their pharmacist were also conducted (n = 10). Using an interpretivist approach, five ‘demand-side’ dimensions of Levesque’s access conceptual framework were explored (ability to perceive a need for medication support, their ability to seek this support, ability to reach the pharmacy, ability to pay and engage). Results: The findings exposed the medicine, health and social care challenges of vulnerable people and how these are often not being adequately managed or met. Using the access formwork, we unpack and demonstrate the significant challenges patients face accessing pharmacy support. Discussion: Pharmacy organizations need to pay attention to how patients perceive the need for pharmacy support and their ability to seek, reach and engage with this. Further training may be needed for community pharmacy staff to ensure services are made accessible, inclusive and culturally sensitive. Effective engagement strategies are needed to enable the provision of a flexible and adaptable service that delivers patient-centred care. Policy makers should seek to find ways to reconfigure services to ensure people from diverse backgrounds can access such services.

Azithromycin Treatment vs Placebo in Children With Respiratory Syncytial Virus–Induced Respiratory Failure

Despite a high disease burden, there is no effective treatment for respiratory syncytial virus (RSV) infection. To determine whether administration of azithromycin (AZM) to children with RSV-induced respiratory failure is safe and to define the effect of AZM therapy on nasal matrix metalloproteinase 9 (MMP-9) levels. This randomized, double-blind, placebo-controlled phase 2 trial was conducted at a single tertiary pediatric intensive care unit from February 2016 to February 2019. The study included children with RSV infection who were admitted to the pediatric intensive care unit and required respiratory support via positive pressure ventilation (invasive and noninvasive). A total of 147 children were screened; 90 were excluded for not meeting inclusion criteria, having an absent legal guardian, lacking pharmacy support, or having a language barrier and 9 declined participation, resulting in 48 patients enrolled in the study. Receipt of standard dose AZM (10 mg/kg/d), high-dose AZM (20 mg/kg/d), or a matching placebo of normal saline intravenously for 3 days. Nasal and endotracheal samples were collected at baseline as well as at 24 hours and 48 hours after start of treatment. The secondary outcome was to determine treatment effect on clinical outcome measures, including days of positive pressure ventilation and length of hospital stay. A total of 48 patients were enrolled in the trial, with a median (range) age at randomization of 12 (1 to 125) months; 36 participants (75.0%) were younger than 2 years. Overall, 26 participants (54.2%) were boys, and 29 (60.4%) had a comorbidity. A total of 16 patients were randomized into each trial group (ie, placebo, standard-dose AZM, and high-dose AZM). Baseline demographic characteristics were comparable among the 3 groups. Both doses of AZM were safe, with no adverse events observed. No difference in nasal MMP-9 levels were observed between treatment groups. Among those who required mechanical ventilation and received high-dose AZM, endotracheal active and total MMP-9 levels were lower on day 3. Compared with baseline, active and total MMP-9 levels in endotracheal aspirates were 1.0 log lower in the high-dose AZM group (active MMP-9: 99.8% CI, -1.28 to -0.64; P < .001; total MMP-9: 99.8% CI, -1.37 to -0.57; P < .001). Patients who received high-dose AZM had fewer median (interquartile range) hospital days compared with those receiving the placebo (8 [6-14] days vs 11 [8-20] days; mean ratio estimate, 0.57; 95% CI, 0.38-0.87; P = .01). In this phase 2 randomized clinical trial, both doses of AZM were safe. While nasal MMP-9 levels were unchanged among treatment groups, endotracheal MMP-9 levels were lower among those who received high-dose AZM. The positive secondary clinical outcome, while exploratory, provides insight for end points in a multicenter randomized trial. ClinicalTrials.gov Identifier: NCT02707523.

Health-system pharmacy department preparation and support for nursing workforce disruption.

Health-system pharmacy department preparation and support for nursing workforce disruption.

Exploring the factors influencing the quality of "Health Support Pharmacy" services in Japan: Perspectives of community pharmacists.

Internationally, community pharmacists play a key role in public health services. In Japan, a new system called Health Support Pharmacy (HSP) was introduced in 2016, to promote responsible self-medication with non-prescription medicines and increase awareness of public health activities provided through community pharmacies. The number of HSP services provided has been increasing; however, the service quality varies depending on pharmacies and/or pharmacists. Thus, it is important to identify factors that influence HSP service quality. To identify factors that can impact on the quality of HSP services provided by community pharmacists in Japan. In-depth semi-structured online interviews were conducted with twenty-four community pharmacists from across Japan. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. All themes identified were deductively categorised into 3 domains using Donabedian's framework of structure, process and outcome. Participants identified 8 key themes and 23 sub-themes pertaining to the quality of pharmacy public health services. For the structure domain these were: adequate resources, professional expertise, and policy and procedures. For the process domain these were: provision of individual services, provision of community health education and other events, and collaboration with other professionals. For the outcome domain these were: impact on individuals and the general public, and impact on other professionals. This study identified factors which can impact HSP service quality by community pharmacists in Japan. Whilst the major themes identified align with those reported in other studies pertaining to expanded roles for community pharmacists, this study also identified findings which appear to be unique to the Japanese context. These findings, based on Donabedian's framework, may be used to better understand the scope and quality of HSP services delivered in Japan.

Pharmacy support needed early on in hospital stay for medication-related problems

Pharmacy support needed early on in hospital stay for medication-related problems

Primary health care policy and vision for community pharmacy and pharmacists in Lebanon.

Within a crippling economic context and a rapidly evolving healthcare system, pharmacists in Lebanon are striving to promote their role in primary care. Community pharmacists, although held in high esteem by the population, are not recognised as primary health care providers by concerned authorities. They are perceived as medication sellers. The role of the pharmacist in primary health care networks, established by the Ministry of Public Health (MOPH) to serve most vulnerable populations, is limited to medication delivery. The practice of the pharmacy profession in Lebanon has been regulated in 1950 by the Lebanese Pharmacists Association [Order of Pharmacists of Lebanon] (OPL). In 2016, the OPL published its mission, vision, and objectives, aiming to protect the pharmacists’ rights by enforcing rules and procedures, raise the profession’s level through continuous education, and ensure patients’ appropriate access to medications and pharmacist’s counseling for safe medication use. Since then, based on the identified challenges, the OPL has suggested several programs, inspired by the World Health Organization and the International Pharmaceutical Federation guidelines, as part of a strategic plan to develop the pharmacy profession and support patient safety. These programs included the application of principles of good governance, the provision of paid services, developing pharmacists’ core and advanced competencies, generation of accreditation standards for both community pharmacy and pharmacy education, suggesting new laws and decrees, continuing education consolidation and professional development. There was an emphasis on all decisions to be evidence assessment-based. However, OPL faces a major internal political challenge: its governing body, which is reelected every three years, holds absolute powers in changing strategies for the three-year mandate, without program continuation beyond each mandate. Within this context, we recommend the implementation of a strategic plan to integrate pharmacy in primary health centers, promoting the public health aspect of the profession and taking into account of critical health issues and the changing demographics and epidemiological transition of the Lebanese population. Unless the proposed blueprint in this paper is adopted, the profession is unfortunately condemned to disappear in the current political, economic and health-related Lebanese context.

The Japanese Community Pharmacists’ Perceptions of the Health Support Pharmacy System

A questionnaire survey was conducted employing pharmacists at 350 Japanese Federation of Democratic Medical Institutions (Min-Iren) member pharmacies, evaluating the challenges related to registering as a Health Support Pharmacy (HSP). Completed responses were received from 193 pharmacies (55.1%). Fifty-five (28.5%) of these pharmacies were approved as meeting the HSP criteria. Some difficulties encountered in registering as an HSP included the preparation of the numerous required documents and placing a health support pharmacist. The obstacles that prevented pharmacists from registering were physical, including “placement of two or more health support pharmacists” and “placement of the required over-the-counter drugs (OTCs).” Based on these, 51.8% of supervising pharmacists stated the opinion that the government should “loosen current criteria.” However, a survey conducted among the 724 participant pharmacists, working in a pharmacy, showed no significant difference in their answering tendencies depending on whether or not they worked at an HSP. This could be attributed to the effort that Min- Iren pharmacies have been putting into health support and primary care functions. Overall, 64.5% of pharmacists working at HSPs were proud that the pharmacy they worked had HSP status. The present survey revealed the physical obstacles of HSP registration. Conformity to the criteria of HSP is essential for performing their fundamental functions as pharmacies. The relaxation of the criteria is anticipated.

Back to Basics: Medication Safety.

Perioperative nurses administer some medications but are primarily responsible for obtaining, preparing, and documenting medications. Unlike personnel in many other patient care areas, perioperative personnel may not have immediate access to a pharmacist; this lack of pharmacy support can complicate medication administration processes. A variety of medication errors occur in the perioperative setting and can negatively affect patients and personnel. Perioperative nurses should review regulatory information and professional organization guidance documents when they work with other health care team members to address medication safety issues. Some recommendations include submitting clear medication orders, using aseptic technique when transferring medications to the sterile field, and using standardized labeling. In addition, perioperative nurses should obtain only one patient's medications from a dispensing unit at a time and prepare one medication at a time. After reviewing this article and the supporting literature, perioperative nurses should have increased knowledge about medication safety.

Evaluation of the Collaboration between Community Interprofessionals and Pharmacists for Early Detection of Dementia

The purpose of this study is to evaluate the collaboration system between Muscat Pharmacy and community general support center by verifying the results of tests for early detection of dementia, and the early support response for the participants with suspected dementia by the center. From December 2016 to November 2018, we conducted measurement sessions using a touch panel-type test, MSP-1100 at 23 events that included health promotion classes and local community events directed by community general support center. At a later date, a visit survey was administered by the center to the participants with suspected dementia those who received a score lower than 12, and their individual records of early support responses and follow-ups were evaluated and analyzed. During the period, 597 participants had measurements taken with the touch panel-type test. Among them, 89 (14.9% of total) participants received a score lower than 12. The contents of the support by the center for the low-scoring participants were classified into nine categories. Forty of the 89 low-scoring participants were judged to have no problems. Others were cooperatively followed up with medical consultation recommendation, receiving home care management, and/or having their information provided physicians by the Muscat pharmacy and the center. The results of our study indicate that the cooperation between community pharmacy and community general support centers could allow for the early detection of dementia and follow-ups for suspected dementia.

Community pharmacy personnel interventions for smoking cessation.

Community pharmacists could provide effective smoking cessation treatment because they offer easy access to members of the community. They are well placed to provide both advice on the correct use of smoking cessation products and behavioural support to aid smoking cessation. To assess the effectiveness of interventions delivered by community pharmacy personnel to assist people to stop smoking, with or without concurrent use of pharmacotherapy. We searched the Cochrane Tobacco Addiction Group Specialised Register, along with clinicaltrials.gov and the ICTRP, for smoking cessation studies conducted in a community pharmacy setting, using the search terms pharmacist* or pharmacy or pharmacies. Date of the most recent search: January 2019. Randomised controlled trials of interventions delivered by community pharmacy personnel to promote smoking cessation amongst their clients who were smokers, compared with usual pharmacy support or any less intensive programme. The main outcome measure was smoking cessation rates at six months or more after the start of the intervention. We used standard methodological procedures expected by Cochrane for study screening, data extraction and management. We conducted a meta-analysis using a Mantel-Haenszel random-effects model to generate risk ratios (RRs) and 95% confidence intervals (CIs). We identified seven studies including 1774 participants. We judged three studies to be at high risk of bias and four to be at unclear risk. Each study provided face-to-face behavioural support delivered by pharmacy staff, and required pharmacy personnel training. Typically such programmes comprised support starting before quit day and continuing with weekly appointments for several weeks afterwards. Comparators were either minimal or less intensive behavioural support for smoking cessation, typically comprising a few minutes of one-off advice on how to quit. Participants in both intervention and control arms received equivalent smoking cessation pharmacotherapy in all but one study. All studies took place in high-income countries, and recruited participants visiting pharmacies. We pooled six studies of 1614 participants and detected a benefit of more intensive behavioural smoking cessation interventions delivered by community pharmacy personnel compared with less intensive cessation interventions at longest follow-up (RR 2.30, 95% CI 1.33 to 3.97; I2 = 54%; low-certainty evidence). Community pharmacists can provide effective behavioural support to people trying to stop smoking. However, this conclusion is based on low-certainty evidence, limited by risk of bias and imprecision. Further research could change this conclusion.