An evaluation of a rural community pharmacy-based smoking-cessation counselling and nicotine replacement therapy initiative

Abstract

Objective To evaluate the efficiency and the effectiveness of a rural community pharmacy-based smoking-cessation counselling and nicotine replacement therapy (NRT) initiative. Setting Community pharmacies in NHS Highland in the north of Scotland. Methods A review of the literature on community pharmacy-based smoking-cessation initiatives informed a performance assessment framework. Data for evaluation were collected through client records, questionnaires and semi-structured interviews of the stakeholders, and a cost-effectiveness analysis was undertaken. Key findings Most clients (77%) smoked cigarettes for an average of 34 pack-years ranging from 1 to 174 pack-years. Almost three-quarters (73%) of the NRT prescribed was in the form of patches. Most respondents (91%) claimed pharmacists' advice was useful, and most (65%) thought that the pharmacist was their preferred healthcare professional for smoking-cessation advice because of ease of access. At the end of week four, 45% of clients reported that they had stopped smoking, this fell to 35% at the end of week 12, and at 44 weeks the point prevalent abstinence rate was 15.8%. Of those that did not stop, 19% reduced their smoking level. This initiative cost £525 for each quitter. Thirteen quality criteria were defined in the assessment framework of which six were achieved. Conclusions There are no established criteria for evaluating community pharmacy-based smoking-cessation initiatives currently available, neither are reductions in smoking levels reported. Enhancing the role of the community pharmacist to include health improvement improves the interface between healthcare and the consumer, and helps to meet the national recommendations. Community pharmacy-based smoking-cessation initiatives impact on smoking-cessation targets, allow for the variety of services relevant to the needs of the population and are part of the key to making a difference.In 1997, cigarette smoking accounted for an estimated 117 400, or one-fifth of all deaths in the UK, translating to 13 deaths every hour. 1 Despite this and tobacco smoking now being a long-established cause of ill-health, 2 one-third of both men and women in Scotland continue to smoke, of whom half will die of smoking-related illness. 3,4 Of current smokers in Scotland, 70% would like to stop, and of these 90% want to stop for a health reason; over half of those that had successfully stopped had sought advice to help them. 5 There is a clear need for effective smoking-cessation programmes.The Highland region in the North of Scotland has a population of 208000 people in one-third of the total Scottish landmass. It covers an area the size of Belgium, is the least densely populated area of Scotland with 0.08 people per hectare, 6 and is predominantly rural. The Scottish Index for Multiple Deprivation (SIMD) ranks electoral ward areas from the highest position of 1 to the lowest of 1222 according to the score for the measure of deprivation. In the Highland region, the average rank position for overall deprivation is 626 out...

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