Exploring Challenges, Opportunities for Community Pharmacists in Tobacco Cessation

Although community pharmacists are well positioned to help patients stop smoking through tobacco cessation programs, practical challenges complicate their integration, according to new research published in the tenth anniversary special issue of Pharmacy.¹ Understanding these challenges can bridge the gap in tobacco cessation treatment.

Tobacco use increases health care spending and poses risks to the health of smokers. Despite an increased awareness about the dangers of smoking, readily available cessation treatments, and a strong desire to quit reported among two-thirds of individuals who smoke, less than 5% of solo attempts at quitting are successful.¹

Past research has demonstrated the potential of community pharmacists to assist individuals in successful quitting attempts, namely because of their wide reach and status as trusted health care providers. However, more research is needed on best practices for implementing tobacco cessation services in the community pharmacy practice.

To characterize facilitators and barriers associated with the introduction of tobacco cessation services to community pharmacy settings, investigators evaluated pharmacy personnel’s perceptions associated with the integration of the programs.

Seven community pharmacies in California affiliated with the Community Pharmacy Enhanced Services Network participated in the study. A total of 48 participants—22 pharmacists and 26 pharmacy technicians—underwent web-based tobacco cessation training aligned with their roles.

Once tobacco cessation programs were implemented, pharmacy personnel participated in semi-structured interviews to provide insights on their integration. Interviews were guided by Rogers’ Diffusion of Innovations Theory,¹ a framework that evaluates the successful adoption of a new protocol through 5 constructs:

• Relative advantage (ie, the degree to which the new service is perceived by pharmacy staff as better than previous practices)
• Compatibility (ie, the new service is perceived as being consistent with the values, past experiences, and needs of the community pharmacy setting)
• Complexity (ie the degree to which the new service is perceived as difficult to implement and use)
• Trialability (ie the degree to which experimentation is possible with the new service)
• Observability (ie, the ability to see the impact of implementing the new service)

Investigators gleaned a variety of advantages and challenges associated with implementing smoking cessation programs in a community pharmacy setting. Staff reported that they initially struggled to incorporate routine questions about tobacco use into their standard practice. Pharmacy infrastructure, like management software, was identified as one way to overcome this barrier.

“We’re very fortunate that our pharmacy software [vendor] updated their system, so we have a method to capture [tobacco use] in the software now,” said one participant of the study.¹ “We were previously just marking it on their profile and having to put notes and stuff. Now we have fields that capture it, so it makes it much easier for us to see who’s already been asked, what their status is, and what steps we need to take going forward.”

Responses also revealed that the involvement of pharmacy technicians and clerks as “champions” that supported the implementation of the program allowed pharmacists to spend more time advising and counseling patients. Their success signaled the potential of non-pharmacy staff to assume more integral roles in improving the health of patients.

“Pharmacists and pharmacy technicians play a pivotal role in providing effective support for tobacco treatment and other related health issues,” said Robin Corelli, study co-author and UC San Francisco pharmacy faculty member, in a release.² “Being part of the local community is important and we need sustainable models for providing these services.”

In addition, billing and reimbursement were identified as primary roadblocks to program integration. Investigators suggested that strategies are needed to “change record systems” to allow for better data monitoring and to “make billing easier.”¹

By addressing the barriers identified in the current study, such as routine implementation and reimbursement hurdles, community pharmacists can “significantly impact public health by increasing access to effective cessation support,” wrote investigators.¹ The need to do so remains ever-present, especially as the tobacco crisis evolves and further complicates cessation initiatives.

“Cigarette smoking is the chief, single avoidable cause of death in our society and the most important public health issue of our time,” said Karen S. Hudmon, lead study author, at a session at this year’s American Pharmacists Association Annual Meeting & Exposition,³ reciting a 1982 quote from Surgeon General C. Everett Koop to highlight the persistence of tobacco use as an issue in the US. Although cigarette smoking rates are on the decline, the introduction of electronic nicotine delivery systems has sustained a national and global dependence on nicotine.

The Surgeon General's declaration of a youth e-cigarette epidemic in 2018 highlights the need for continued vigilance in the fight against tobacco use.⁴

The ongoing initiative against tobacco demands innovative solutions. Equipping community pharmacists with the tools and resources they need can not only improve patient outcomes, but also make an impact on public health.

READ MORE: Respiratory Resource Center

References

1. Ellis Hilts K, Elkhadragy N, Corelli RL, Hata M, Tong EK, Vitale FM, Hudmon KS. Closing the tobacco treatment gap: A qualitative study of tobacco cessation service implementation in community pharmacies. Pharmacy. 2024; 12(2):59. https://doi.org/10.3390/pharmacy12020059

2. EurekAlert. New study confirms community pharmacies can help people quit smoking. News release. April 22, 2024. Accessed April 23, 2024. https://www.eurekalert.org/news-releases/1042092

3. Hudmon KS, Corelli RL. Captain Hooked: Updates on Medications for Tobacco Cessation. Presented at: American Pharmacists Association 2024 Annual Meeting and Exposition; March 22-25, 2024; Orlando, FL.

4. Surgeon General’s advisory on e-cigarette use among youth. Fact sheet. CDC. December 2018. Accessed April 23, 2024. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/surgeon-general-advisory/index.html