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 Pharmaceutical Society, 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, “Helping
smokers to stop: advice for pharmacists in England”, 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 contact 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, plus 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 public
health publications section of the NICE website. It can also
be reached by a link from the practice
guidance page 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 Pharmaceutical Society, 1 Lambeth High
Street, London SE1 7NJ (tel 020 7572 2208;
e-mail qualityimprovement@rpsgb.org).
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