Exploration of characteristics of community pharmacies that may influence the successful outcomes of Stop Smoking Services

Abstract

BACKGROUND: National Health Service (NHS) Lothian community pharmacies contracted to deliver the Stop Smoking Service have varying success rates. A clearer understanding of the factors or predictors which may impact on the success of the NHS community pharmacy Stop Smoking Services is required by NHS Lothian Public Health Directorate. AIM:To describe the characteristics of community pharmacies within one health board delivering Stop Smoking Services and propose characteristics which in future studies can be tested for association with stop smoking success rates. METHODS: A questionnaire survey and a national database recording success rates and client demographics were used to explore characteristics of the pharmacies. Data collected included details of client recruitment methods; staff training; number, type and continuity of staff; use of consultation room; approach used; use of appointments; use of carbon monoxide monitoring and perceived outcomes from repeated quit attempts. Pharmacy responders and demographics of clients were separated into three arbitrary pharmacy categories based on their success rate to provide a guide to potential predictors of success. RESULTS: During 2012, the 182 pharmacies achieved a median (interquartile range (IQR)) of 19 (6 – 45) quit attempts. The IQR of stop smoking success rates (self-reported quits at 4 weeks) among the pharmacies was 25.8% to 55.1%. Of all responders, 67.6% reported that over 80% of all initial consultations were held in the consulting room. Of all responders, 38.4% reported that over 80% of all follow-up consultations were held in the consulting room. The highest proportion of responders (60.5%) reported that pharmacy staff had utilised NHS smoking cessation training, whilst a similar proportion of responders (53.9%) reported pharmacy staff had utilised sponsored training and employment training. The majority of responders (53.3%) reported that pharmacy staff had undertaken one-off training. A higher proportion (χ2(1) = 14.298, p < 0.001) of responders with a success rate ≥ 41% and with client quit attempts ≥ 10 had clients over 45 years of age compared to responders with a success rate < 41% and with client quit attempts ≥ 10. Using the same arbitrary groups there was a difference in the proportion of males and females having a successful quit attempt (χ2(1) = 4.035, p = 0.045) and the proportion of employed clients and non-employed clients having a successful quit attempt (χ2(1) = 16.197, p < 0.001). Other data collected for pharmacy factors did not suggest any potential influence on success rates. There was consensus that pharmacies would like to receive feedback on their success rates which currently does not happen. CONCLUSION: There is a wide range of quit attempts and quit rates across 182 community pharmacies in NHS Lothian. For those pharmacies that do not use the consulting room frequently, should be encouraged to utilise it more. Gender, age, employment status of clients and use of the consultation room in community pharmacies should be tested for association with successful smoking cessation outcomes. Pharmacies should be provided with their success rates as a potential motivator. There is a wide range in the access to and frequency of training by pharmacy staff delivering the service. The recommendation is to review the training undertaken by pharmacy staff who are delivering the service in NHS Lothian. Consideration should be given to defining levels of competence to deliver the service to help assure a minimum standard of service delivery.