By Deepak Lodhia
With 14.4 per cent of UK adults currently classified as smokers, smoking places a significant demand on community, primary and secondary health and social care services.
Each year, smoking attributes to nearly 500,000 hospital admissions and around 80,000 preventable deaths. Furthermore, it costs the NHS approximately £2billion to treat diseases related to smoking.
With one in two smokers dying from a smoking-related disease, quitting is one of the best things a patient can do for their health and it’s important all pharmacists are able to encourage patients to stop smoking.
As pharmacists, we interact with millions of patients per year making us well placed to engage patients in smoking cessation advice.
Community pharmacies are often the first port of call for minor ailments. A patient purchasing over-the-counter medicines for a common cough and cold can be asked whether they smoke.
Similarly, the dispensing of many types of medication can be linked with smoking cessation advice including medication for respiratory and cardiovascular disease, and women using oral contraceptives.
Patients with a prescription for smoking cessation medication should also be asked if they are receiving additional support aside from their prescribed medication. As pharmacists, there are numerous opportunities for us to ask questions and offer advice so it’s important we pursue them.
Only about five per cent of unaided quit attempts result in smokers giving up for good but effective smoking cessation support can significantly increase the chances of success. An effective community pharmacy-based programme should run for three months, include several one-to-one consultations and address some key fundamentals including pleasure, behavior, environment and emotion.
The pleasure, or withdrawal, element of smoking can be counteracted using a variety of pharmacological products. Evidence shows that dual therapy, using a combination of nicotine replacement therapy products, leads to more successful outcomes than treatment with a single product.
Although, a combination of medication and behavioural support is thought to substantially increase the chances of successfully quitting.
This is because behavioral habits are generally harder to break which is why it’s important that all pharmacists are equipped to offer behavioral support which should also help patients deal with emotional triggers.
Furthermore, the patient’s environment plays a huge part in the successfulness of their quitting. If they are surrounded by others who smoke, either at home or work, it might increase their chance of relapsing so it’s important to dress environmental triggers as part of an effective smoking cessation programme.
As with all services, pharmacists who have already received specialist training in smoking cessation should focus on sharing best practice with others. The more we share our successes and our failures, the more we learn and the more we help to drive down the number of smokers.
The first four weeks of a smoker quitting are the most significant. In order to avoid early relapses, it’s vital to build strong initial relationships with patients during this time and ensure they feel comfortable coming back to you for help and advice.
It’s also important to make patients aware of the potential symptoms and pitfalls they might face when attempting to quit and to prepare them to deal with them by introducing appropriate coping strategies.
Establishing the patient’s motivation for wanting to quit is imperative as it can be incorporated into coping mechanisms and help shun the discussed triggers getting in the way of resolve.
Pharmacists who haven’t received specialist training should focus on utilising ‘Healthy Living Zones’ in their pharmacies by displaying useful health-related information.
These zones are brilliant for supporting Public Health England campaigns and initiatives like the recently concluded Stoptober. They can also be a powerful tool to start conversations which will help you make every contact count.
You should get into the habit of ensuring you ask all patients you engage with if they smoke. If they do, try to understand their personal circumstances, advise the patient to quit and the best way for them to do so and always try to encourage one-to-one behavioral support. If they dismiss counselling, discuss the range of products they can access over the counter.
If you want to enhance your smoking cessation knowledge but don’t have availability to specialist training, there are some handy online tools to help you do so.
If pharmacy can deliver successful smoking cessation services, we will help contribute to a healthier and longer-living population and reduce demand on already overstretched healthcare services.
Deepak Lodhia works for a LloydsPharmacy branch in Coventry
This article also appears in the December/January issue of Pharmacy Business.