Effectiveness of intervention to implement tobacco cessation counseling in community chain pharmacies

Abstract

Objective To test the feasibility of implementing ask-advise-refer (AAR) in representative community chain pharmacies serving low socioeconomic areas, and to assess the effectiveness of a multimodal intervention on short-term implementation of AAR. Design Randomized controlled trial Settings Sixteen community chain pharmacies in South-central Wisconsin Intervention A multimodal intervention including: 1) training to implement AAR, 2) workflow integration recommendations, 3) a cessation poster to create awareness, and 4) a support visit. Main outcome measures Number of patrons asked about their tobacco use, number of tobacco users advised to quit, number of quitline cards given, and number of tobacco users enrolled in the quitline. Results As hypothesized, the multimodal intervention significantly predicted the number of patrons asked (estimate=4.84, incidence rate ratios[IRR]=127.2; p<0.001) tobacco users advised (estimate=2.12, IRR=8.33; p<0.01), quitline cards distributed (estimate=1.04, IRR=2.82; p<0.05), and tobacco users enrolled in the quitline (estimate=2.31, IRR=10.13; p<0.001). Conclusion This trial demonstrates the feasibility of implementing AAR in routine community pharmacy practice. This trial also indicates the short-term effectiveness of the intervention in facilitating AAR, implementation in partnership with other public health services and systems. More research is needed to evaluate the generalizability, effectiveness and sustainability of AAR, including factors influencing adoption and the impact on cessation.

Effectiveness of implementation strategies for clinical guidelines to community pharmacy: A systematic review

“…The 22 studies comprised 10 RCTs [54][55][56][57][58][59][60][61][62][63], 3 NRCTs [64][65][66], 1 CBA trial [67] and 8 quasi-experimental or observational studies [68][69][70][71][72][73][74][75] (Tables 1 and 2). The studies were conducted in Australia (n = 8) [54-56, 60, 64, 65, 68, 69], the USA (n = 4) [57][58][59]73], the UK (n = 3) [62,63,75], the Netherlands (n = 2) [61,72], Belgium (n = 1) [67], Canada, (n = 1) [71], Finland (n = 1) [74], Germany (n = 1) [70] and Switzerland (n = 1) [66].…”

“…The studies were conducted in Australia (n = 8) [54-56, 60, 64, 65, 68, 69], the USA (n = 4) [57][58][59]73], the UK (n = 3) [62,63,75], the Netherlands (n = 2) [61,72], Belgium (n = 1) [67], Canada, (n = 1) [71], Finland (n = 1) [74], Germany (n = 1) [70] and Switzerland (n = 1) [66]. The time frame for intervention-duration ranged from 1 day to 2 years.…”

“…They involved chronic disease states [57,60,65,71,75], guidelines for the supply of particular classes of medications [55,56,59,61,64,66,[68][69][70]72], community pharmacy's role in preventative health [58,67,73] and guidelines for appropriate pharmacy practice [63,74]. The variation did not allow for any conclusions to be made about the effectiveness of implementation based on guideline characteristics.…”

“…Implementation activities were targeted to community pharmacy, and in particular to pharmacists in 20 studies [54][55][56][57][58][59][60][61][62][65][66][67][68][69][70][71][72][73][74][75] and pharmacy support staff in 11 studies [56, 58, 61-64, 66, 68, 69, 72, 75]. In two studies, implementation activities were directed exclusively to pharmacy support staff, while three studies involved implementation activities to other health professionals and/or patients as well as community pharmacy staff [58,65,70].…”

“…checklists, patient handouts, documentation forms), was used in seven studies [55,56,58,[60][61][62]. Only one study used practice support as a single intervention [71].…”