Smoking CessationSmoking Cessation

Liz GrantLiz Grant

Lead Public Health PharmacistLead Public Health Pharmacist

NHS Greater Glasgow & ClydeNHS Greater Glasgow & Clyde

BackgroundBackground

Smoking remains the single biggest Smoking remains the single biggest cause of preventable ill healthcause of preventable ill health

Increasing smoking cessation rates Increasing smoking cessation rates represents one of the largest health represents one of the largest health challengeschallenges

BackgroundBackground

Death from CHD is 50% higher in Death from CHD is 50% higher in smokers (> 75% higher in heavy smokers (> 75% higher in heavy smokers)smokers)

30,600 deaths or 27% of all smoking 30,600 deaths or 27% of all smoking attributable deaths in the UK were attributable deaths in the UK were due to cardiovascular diseasedue to cardiovascular disease

After the NS Ban, hospitals saw a After the NS Ban, hospitals saw a 17% reduction in heart attack 17% reduction in heart attack admissions admissions

Benefits of quittingBenefits of quitting

After one year, the excess risk of coronary After one year, the excess risk of coronary heart disease caused by smoking is heart disease caused by smoking is reduced by half reduced by half

Male smokers who quit between 35 and 39 Male smokers who quit between 35 and 39 years add an average of 5 years to their years add an average of 5 years to their lives lives

Female quitters add 3 years Female quitters add 3 years If you've had a heart attack, quitting If you've had a heart attack, quitting

smoking reduces your risk of a subsequent smoking reduces your risk of a subsequent one by 25% one by 25%

Cycle of Change (1)Cycle of Change (1)

Cycle of Change (2)Cycle of Change (2)

Pre-contemplation Smokers in this stage have not yet Smokers in this stage have not yet

considered quitting considered quitting Contemplation

Smokers in this stage are thinking about Smokers in this stage are thinking about stoppingstopping

Determination Determination Smokers in this stage are ready to make Smokers in this stage are ready to make

a cessation attempt a cessation attempt

Cycle of Change (3)Cycle of Change (3)

Action The cessation attempt is put into action The cessation attempt is put into action

Maintenance Maintenance Maintain a smoke-free patient Maintain a smoke-free patient

RelapseRelapse Support the smoker and help them learn Support the smoker and help them learn

from the cessation attempt from the cessation attempt

How is it done in How is it done in practice?practice?

Keep WellKeep Well

"the availability of good medical care tends "the availability of good medical care tends to vary inversely with the needs of the to vary inversely with the needs of the population servedpopulation served.“ Julian Hart,1971.“ Julian Hart,1971

the healthcare services are most likely the healthcare services are most likely to be to be accessible to those who need it accessible to those who need it less less

Scottish Executive funded an anticipatory Scottish Executive funded an anticipatory care service in areas of the greatest need care service in areas of the greatest need to reduce health inequalities by focusing on to reduce health inequalities by focusing on

populations considered to have high risks of CHD populations considered to have high risks of CHD and diabetesand diabetes

Keep Well- The AimKeep Well- The Aim

Strengthen the primary care services Strengthen the primary care services in the most deprived areas in in the most deprived areas in ScotlandScotland

What can Pharmacy Do?What can Pharmacy Do?

In NHS GG&C, introduced Long Term In NHS GG&C, introduced Long Term Medicines ServiceMedicines Service

Support to patients with CHD or Support to patients with CHD or diabetes on four or more medicinesdiabetes on four or more medicines

Monthly reviewsMonthly reviews North, East & SW GlasgowNorth, East & SW Glasgow

How was the Review ConductedHow was the Review Conducted

15-20 minutes15-20 minutes Patient chooses medicine to discussPatient chooses medicine to discuss

What is it for? Open package? Miss a What is it for? Open package? Miss a dose? dose?

Refer/signpost to other servicesRefer/signpost to other services Money Matters; Employability; Smoking Money Matters; Employability; Smoking

Cessation; AlcoholCessation; Alcohol

North CHCPNorth CHCP

February 2007-March 2010February 2007-March 2010 26 pharmacies 26 pharmacies 460 patients 460 patients 85% (392 patients) have received 85% (392 patients) have received

their first reviewtheir first review 51% (235) have received six reviews. 51% (235) have received six reviews. A total of 3,796 reviews were A total of 3,796 reviews were

delivereddelivered

Impact of LTMSImpact of LTMS

Two years before starting the LTMS, Two years before starting the LTMS, the quantities were insufficient in the quantities were insufficient in 68% of cases 68% of cases

Reduced to 27.5% one year after the Reduced to 27.5% one year after the first LTMS review first LTMS review

Improved perceived patient Improved perceived patient compliance compliance

Increased medication awarenessIncreased medication awareness

ConclusionConclusion

Embed learning points into CMSEmbed learning points into CMS Good communication skills pertinent Good communication skills pertinent

to both servicesto both services Body language, empathy, listening Body language, empathy, listening

but not judging, confidence in raising but not judging, confidence in raising the issuethe issue

Someone to talk to, especially for Someone to talk to, especially for elderly patientselderly patients