Does quit-smoking support delivered by community pharmacy staff help people to stop smoking?

Background

Tobacco smoking is the leading cause of preventable death and disease worldwide. Community pharmacists are respected healthcare professionals who provide easily accessible and convenient healthcare services to their communities, and they are well placed to provide their clients with help to quit smoking. Indeed, many governments recognise community pharmacies as a useful way of delivering many healthcare services. However, we need evidence that these services are effective before we develop them more widely.

Study characteristics

We searched for relevant studies in January 2019, and found seven studies including 1774 people. Three studies took place in the UK, and one each in Australia, United States, Qatar, and Italy. Each study provided face-to-face behavioural support delivered by pharmacy staff, who received specific training. Studies compared the structured programme to less intensive support to stop smoking.

Key results

We found evidence that more intensive structured care given by community pharmacy staff probably helps more people to quit smoking than less intensive support to quit.

Quality of the evidence

We found low-quality evidence that community pharmacy support helps people to quit smoking. Limitations of the evidence came from potential problems with the ways some of the studies were carried out and the low numbers of people who quit smoking across the included studies, which means we are not sure how effective these programmes really are.

Authors' conclusions: 

Community pharmacists can provide effective behavioural support to people trying to stop smoking. However, this conclusion is based on low-certainty evidence, limited by risk of bias and imprecision. Further research could change this conclusion.

Read the full abstract...
Background: 

Community pharmacists could provide effective smoking cessation treatment because they offer easy access to members of the community. They are well placed to provide both advice on the correct use of smoking cessation products and behavioural support to aid smoking cessation.

Objectives: 

To assess the effectiveness of interventions delivered by community pharmacy personnel to assist people to stop smoking, with or without concurrent use of pharmacotherapy.

Search strategy: 

We searched the Cochrane Tobacco Addiction Group Specialised Register, along with clinicaltrials.gov and the ICTRP, for smoking cessation studies conducted in a community pharmacy setting, using the search terms pharmacist* or pharmacy or pharmacies. Date of the most recent search: January 2019.

Selection criteria: 

Randomised controlled trials of interventions delivered by community pharmacy personnel to promote smoking cessation amongst their clients who were smokers, compared with usual pharmacy support or any less intensive programme. The main outcome measure was smoking cessation rates at six months or more after the start of the intervention.

Data collection and analysis: 

We used standard methodological procedures expected by Cochrane for study screening, data extraction and management. We conducted a meta-analysis using a Mantel-Haenszel random-effects model to generate risk ratios (RRs) and 95% confidence intervals (CIs).

Main results: 

We identified seven studies including 1774 participants. We judged three studies to be at high risk of bias and four to be at unclear risk. Each study provided face-to-face behavioural support delivered by pharmacy staff, and required pharmacy personnel training. Typically such programmes comprised support starting before quit day and continuing with weekly appointments for several weeks afterwards. Comparators were either minimal or less intensive behavioural support for smoking cessation, typically comprising a few minutes of one-off advice on how to quit. Participants in both intervention and control arms received equivalent smoking cessation pharmacotherapy in all but one study. All studies took place in high-income countries, and recruited participants visiting pharmacies. We pooled six studies of 1614 participants and detected a benefit of more intensive behavioural smoking cessation interventions delivered by community pharmacy personnel compared with less intensive cessation interventions at longest follow-up (RR 2.30, 95% CI 1.33 to 3.97; I2 = 54%; low-certainty evidence).

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