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Pharmacists Adopt Simple Tobacco-Cessation Tools

Jun 01, 2010

ROUGHLY ONE IN FIVE ADULTS in the U.S. uses tobacco products, according to the Centers for Disease Control and Prevention. That figure represents a tremendous opportunity for pharmacists to provide tobacco cessation counseling that can save lives, an opportunity not lost on the profession as a whole.

Karen S. Hudmon, Dr.Ph.

Indeed, roughly 85 percent of pharmacy schools train their students in techniques to help patients stop using tobacco products through Rx for Change, a shared curriculum being disseminated by the University of California-San Francisco Schools of Pharmacy and Medicine and promoted by the ASHP-supported Pharmacy Partnership for Tobacco Cessation (PPTC).

Initiating the Discussion
One of the most useful techniques featured in Rx for Change is a brief intervention called Ask-Advise-Refer (AAR). Using this intervention, pharmacists can ask patients about tobacco use, advise them to quit, and refer them to 1-800-QUIT NOW, a national quitline that connects to counselors located in each patient’s state.

“In many cases, it’s unrealistic for pharmacists to provide comprehensive counseling, from start to finish, so we are also promoting an approach where the pharmacist is the initiator of the quitting process,” said Frank M. Vitale, M.A., national director of PPTC and senior lecturer, pharmaceutical sciences, University of Pittsburgh School of Pharmacy.

“Most people have no idea how to quit,” Vitale adds. “They don’t understand that it’s more than just making yourself stop. So, pharmacists’ referring is a huge intervention because it gets people thinking about actual steps to take.”

Hospital and health-system pharmacists have unique opportunities to help change the tobacco-related behaviors of patients within their care, according to Karen S. Hudmon, associate professor in the Department of Pharmacy Practice at Purdue University, Indianapolis. Hudmon, along with her colleagues at UCSF, developed the Rx for Change curriculum.

“Any pharmacist who has contact with the patient has an opportunity,” she said. “Tobacco use should be addressed with all patients, including, but not limited to, cardiac patients, pulmonary patients, cancer patients, pregnant women, patients with mental illness, and patients undergoing surgery.”

Hudmon noted that hearing about tobacco cessation from a pharmacist reinforces what physicians have already tried to impart. “Studies show that people are more likely to quit when they hear the message through multiple providers,” she said.

A Touchy Subject
One of the challenges of using AAR is getting through the first step—asking a patient if he or she smokes or uses tobacco.

“In clinics, nurses tend to ask because it’s a routine part of their job,” said Alan J. Zillich, Pharm.D., associate professor in the Department of Pharmacy Practice at Purdue and research scientist at the Roudebush Veterans Administration Medical Center in Indianapolis. “But it’s not something that pharmacists have traditionally done, so there isn’t necessarily a routine for incorporating it into our patient interactions.”

Sometimes, the ability to conduct outreach comes down to a simple matter of personal comfort. “There’s a reluctance particular to community pharmacy when it comes to asking people about their tobacco use,” said Zillich. “But if you don’t ask, you can’t help patients quit.”

The approach should always be respectful of the patient, said Hudmon. “Before asking questions about smoking or imparting advice, ask for permission to do so. ‘Do you mind if I ask you a few questions?’ and ‘May I tell you what concerns me [about your smoking]?’ ”

Vitale added that pharmacists often have a ready-made reason for asking: namely, drug interactions. “In training students and clinicians, we provide them with a list of medications known to interact with smoking,” he said. “If a patient is taking a medication that is on the list, that’s a perfect opportunity to start the conversation.”

Vitale, who has counseled more than 15,000 patients about smoking cessation, said that he finds a common theme among tobacco users. “You discover very quickly that most smokers hate it and want to stop,” he said. “But many have that little voice that wants them to find an excuse to continue. If you, as a health professional, don’t say anything, you could be providing them with that excuse to continue.”

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