The Pharmacist September/October 2018 - Page 31

Information and advice pharmacists can give on stop smoking methods Pharmacies are needed more than ever to make smokers aware of the support and treatment options (Act part of the VBA). Stop smoking support and treatment options have changed significantly since the inception of evidence-based NHS stop smoking services in 2000. It’s important to understand that not every smoker will want to attend weekly sessions of behavioural support and may prefer more flexible approaches including self-help. We also need to factor in budget cuts across many local authorities and in some instances the de-commissioning of services, including those in community pharmacies. Examples of support and treatment options that may be available to your smoker: • Talking to a specialist stop smoking adviser in the pharmacy who has undergone intensive training: With up to 300% success rates, 8 this option will provide the best possible chance for a smoker to stop for good. Patients will need to commit to weekly appointments for at least four weeks after their quit date. Pharmacies are ideally placed for this to occur as they are easily accessible, can offer flexibility with long opening hours, and some consultations can be done over the phone. • Using a stop smoking medicine: Community pharmacists are in an ideal position to offer this model of support. It would usually entail offering NRT (usually combination) or varenicline to a patient. The medicines will be discussed in detail prior to going smokefree and then in follow-up advice at some point soon after quit date. Patients’ chances of stopping may increase by 100%. • Stop smoking alone or with minimal support: For patients who want minimal support, it may be worth signposting them to reputable websites that offer tips, the chance to chat to an adviser online or, potentially, over the phone. Even though it is not the most effective option, patients doing it alone and stopping abruptly, potentially with the support of e-cigarettes to assist, are up to 50% more likely to quit smoking. 9 • Buying NRT OTC: According to data conducted each year from the Smokers Toolkit Study (STS), buying NRT OTC has been shown not to improve a smoker’s chances of stopping smoking. This is a large reason why pharmacists shouldn’t encourage this option. 10 How to motivate and help patients to go smokefree For pharmacy staff who are offering more intensive stop smoking support and treatment, it is recommended to do the NCSCT core knowledge and skills online course, pass the assessment and attend a locally commissioned, accredited face-to- face training that follows national training standards. 11 The standard treatment programme has a set of competencies that should be covered in the sessions to help motivate a smoker to stop for good using motivational skills. 12 Part of the programme will include asking the smoker about their current smoking habits, their motivation to stop and past quit attempts. Discussing medication options and offering an informed choice will further support the patient. Conducting a carbon monoxide reading on each visit is a great motivational tool to highlight improved levels. Offering a summary throughout, with plenty of encouragement, will hopefully bolster the patient’s confidence further. In each of the sessions, asking the patient to make a commitment to not have a single puff of a cigarette (including roll-ups, shisha, cigars etc) will help them see themselves as a proud non-smoker and set them up for longer-term success. If there are lapses, it’s important to remind the patient that we’re all human and mistakes can happen on the way to become a lifelong non-smoker. Many patients will need multiple attempts before successfully going smokefree. Darush Attar-Zadeh is a medicines optimisation pharmacist at London Procurement Partnership and clinical lead (respiratory project) for medicines optimisation at Barnet Clinical Commissioning Group (CCG) References 1 digital.nhs.uk/catalogue/PUB24228 2 slideshare.net/PublicHealthEngland/local-tobacco-control- profiles-july-2018?from_action=save 3 slideshare.net/PublicHealthEngland/local-tobacco-control- profiles-july-2018?from_action=save 4 Szatkowski L, Murray R, Hubbard R et al. Thorax 2015;70: 498–500 5 slideshare.net/PublicHealthEngland/local-tobacco-control- profiles-july-2018?from_action=save 6 ncsct.co.uk/publication_very-brief-advice.php 7 ncsct.co.uk/usr/pub/Working%20with%20vape%20shops.pdf 8 london.stopsmokingportal.com/stop-smoking 9 london.stopsmokingportal.com/stop-smoking/alone-with- websites-and-apps 10 view.officeapps.live.com/op/view. aspx?src=http%3A%2F%2Fwww.smokinginengland.info%2Fdow nloadfile%2F%3Ftype%3Dlatest-stats%26src%3D8 11 ncsct.co.uk/publication_ncsct-training-standard-learning- outcomes-for-training-stop-smoking-practitioners.php 12 ncsct.co.uk/pub_tr r&W6W&6W26WFV&W"7F&W"#FR&67B3