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STOP

 

STOP

Full title: Optimising pharmacist-based treatment for smoking cessation

Acronym: STOP

Research Funder: National Institute for Health Research, PGfAR

Research status: In set-up

Smoking is the major cause of preventable illness and death in the UK.  However people who stop smoking very quickly lose their increased risk of disease, so about ten years after stopping the risk has fallen to the same level as for someone who has never smoked. Thus stopping smoking is one of the most important moves towards a healthier lifestyle. Pharmacists are an important and easily accessible front line service for NHS primary care services such as the Stop Smoking programme.   Pharmacy staff have contact with healthy people, those who are ill, young people and those less likely to attend more formal healthcare settings. Thus expanding the role of the pharmacist to deliver a wider range of clinical services is high on the government agenda for developing primary health care.

Smoking cessation was one of the first of the new clinical areas taken up by pharmacists and this has been very successful so 35,000 quit attempts now occur in pharmacies in London each year. To date however there has been very little research to find the best ways of helping people to stop smoking in this setting and while a large proportion of service users passing through the pharmacy NHS Stop Smoking programme quit, a significant number do not so quit rates in this setting are consistently lower than those seen in specialist smoking cessation clinics.

We aim to increase numbers of smokers quitting in the pharmacy based Stop Smoking service by designing and testing a new training programme to build pharmacists' consultation skills and knowledge aiming to increase the numbers of smokers enrolling and staying in the Stop Smoking programme and increasing the proportion of those people in the programme who successfully quit. The aim is to help pharmacists to talk to and support smokers more effectively when they see them about quitting smoking and to encourage them to join the pharmacy NHS Stop Smoking programme. We will use evidence from two main sources to design the training programme which we will then test in practice by conducting a randomised controlled trial. Altogether we have planned a 5 year study.

Source 1: We are reviewing the evidence that currently exists, by doing systematic and rigorous literature searches. We are considering all studies focused on changing health behaviours in a pharmacy setting whether this is smoking or some other health behaviour such as using sunscreens. We will examine which techniques are associated with successful health behaviour change in people which results in them adopting a more healthy lifestyle.

Source 2: We will audiorecord real life Stop Smoking consultations between pharmacists and smokers as they happen and then follow up the smokers  to see if they have quit or not at six months. To verify this we will take cheek swab and saliva samples at baseline and at 6 months. We will use the samples to do a chemical test of nicotine levels to tell whether or not the person has quit. We may also use the samples for a genetic analysis of the smokers since there is some evidence to suggest that different people may be genetically programmed to process nicotine in their bodies at different rates.

We will analyse a selection of recordings of smokers who have and have not quit to see if there are techniques that pharmacists use in Stop Smoking consultations that can be linked to smokers successfully quitting. We also plan to interview pharmacists and smokers after successful and unsuccessful quit attempts to further help us to explore key elements of the interaction that lead to success.

Development of the educational programme for pharmacists: These two sources of information – the review of research already undertaken, and our own study of the interaction between pharmacists and smokers in Stop Smoking consultations - will feed directly into development of the educational programme.  Depending on what the evidence suggests, this might for example consist of a training workshop or a DVD giving pharmacists examples of effective techniques with explanations of how and why they work.

Evaluation: When the educational programme has been developed we will pilot it in a few pharmacies and then undertake a full scale evaluation using a randomized controlled trial in a large number of pharmacies in East London.

Investigators

Chief investigator:

Professor Robert Walton, Professor of Primary Medical Care, Blizard Instititute, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Email: r.walton@qmul.ac.uk

Project Manager:

Dr Carol Rivas, Postdoctoral Research Fellow, Qualitative Lead for NIHR Research Design Service London, Blizard Instititute, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Email: c.a.rivas@qmul.ac.uk

Systematic review core team:

Dr Liz Steed, Health Psychologist (lead for the study's systematic reviews), Blizard Instititute, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Email: e.a.steed@qmul.ac.uk

David Salisbury, Blizard Instititute, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Dr Pierre Durieux, Sante Publique Informatique Medicale, Faculté de Médecine Broussais Hôtel Dieu et Hôpital Européen

Dr Elizabeth Edwards, Academic Clinical Fellow, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Qualitative study core team:

Dr Carol Rivas, Postdoctoral Research Fellow (lead on the qualitative study), Blizard Instititute, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Email: c.a.rivas@qmul.ac.uk

David Salisbury, Blizard Institute, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Laurence Antao, STOP Research Assistant, Blizard Institute, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Email: l.antao@qmul.ac.uk

Dr Asmat Syed, STOP Research Assistant, Blizard Institute, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London 

Email: asmat.syed@qmul.ac.uk

Co-investigators:

Professor Stephanie Taylor, Professor in Public Health and Primary Care, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Email: s.j.c.taylor@qmul.ac.uk

Professor Chris Griffiths, Professor of Primary Care, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Email: c.j.griffiths@qmul.ac.uk

Professor Sandra Eldridge, Professor of Biostatistics, Centre for Primary Care & Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary University of London

Email: s.eldridge@qmul.ac.uk

Dr Matthew Taylor, Project Director, Pharmacoeconomics, York Health Economics Consortium

Email: mt25@york.ac.uk

Professor Peter Hajeck, Head of Psychology, Department of Human Science and Medical Ethics, Wolfson Institute of Preventive Medicine, Barts and The London

Email: p.hajek@qmul.ac.uk

Mr Jonathan Mason, National Clinical Director for Primary Care and Community Pharmacy, Department of Health

Email: Jonathan.Mason@chpct.nhs.uk

Professor Neal Benowitz, Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco

Email: nbenowitz@medsfgh.ucsf.edu

Ms Jill Goaddard, Tower Hamlets PCT

Email: jill.goddard@thpct.nhs.uk

Dr Ian Basnett, Joint Director of Public Health, Tower Hamlets PCT

Email: Ian.Basnett@thpct.nhs.uk

Dr Pierre Durieux, Sante Publique Informatique Medicale, Faculté de Médecine Broussais Hôtel Dieu et Hôpital Européen

Email: pierdurieux@gmail.com

Mrs Elizabeth Bayliss, Director, Social Action for Health

Email: elizabethb@safh.org.uk

Professor Athol Johnston, Professor of Clinical Pharmacology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry

Email: a.johnston@qmul.ac.uk

Mr Jonathan Davies, Community Pharmacist, Forward Pharmacy, Mile End

Professor Trisha Greenhalgh, Professor of Primary Health Care, Blizard Institute, Centre for Primary Care & Public Health, Barts and the London School of Medicine and Dentristry, Queen Mary University of London

Email: p.greenhalgh@qmul.ac.uk

Staff:

Sandy Smith; Vichithranie Madurasinghe.

Background

Smoking causes more than 100,000 deaths annually in the UK and is a major preventable cause of heart disease, stroke, chronic respiratory disease and cancer. [1] In East London the health burden from tobacco is high: 47% of residents smoke and 22% of deaths in Tower Hamlets are due to tobacco compared to 18% in London overall. [2] Importantly, a smoker who stops smoking at age 30 is likely to live as long as someone who has never smoked. [3] Thus smoking cessation is a major public health priority.[4] Pharmacists are an important and easily accessible front line service for NHS primary care. Pharmacy staff have contact with healthy people, those who are ill, young people and those less likely to attend more formal healthcare settings. NHS policy is to strengthen primary care delivery through the pharmacies. [5] Smoking cessation was one of the first clinical areas taken up by pharmacists and 35,000 quit attempts occur in pharmacies in London each year. [6] To date however there has been very little research to find the best ways of helping people to stop smoking in this setting and while a large proportion of service users quit, a significant number do not after passing through the pharmacy Stop Smoking programme. We aim to increase capacity of the pharmacy based Stop Smoking service by designing and testing a new training programme to build on pharmacists' consultation skills and knowledge, aiming to increase the numbers of smokers enrolling and staying in the Stop Smoking programme and successfully quitting.

  1. Allender, S., et al., The burden of smoking related ill health in the UK. Tob Control, 2009. 18(4): p. 2627.
  2. Anon, Tower Hamlets Primary Care Trust Annual Report. 2008.
  3. Peto, R., et al., Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case control studies. BMJ, 2000. 321(7257): p. 3239.
  4. Anon, Consultation on the future of tobacco control. 2008: Department of Health.
  5. Anon. Pharmacy based stop smoking services: optimising commissioning. NHS employers, London, 2009
  6. Anon, Statistics on NHS Stop Smoking Services: England, April 2008 to March 2009, in NHS Information Centre. 2010, Health and Social Care Lifestyles Statistics.

Research Plans

PHASE 1: A Cochrane systematic review and meta-analysis of studies on changing health behaviours in pharmacies. The aim of this phase is to identify aspects of successful interventions that could be applied to smoking cessation, particularly underlying theories, as well as a review of reviews and a qualitative meta-synthesis. We will also update our review of computer advice on drug dosing to identify features of successful systems that might be used in future to help pharmacists to select the most appropriate drug therapy and dose to help someone to stop smoking.

PHASE 2: Qualitative research involving pharmacy NHS Stop Smoking advisors and their service users to identify key elements of their interactions that are associated with success.

We will audio record consultations, with some limited non-participant observation, and interview participants. We may also interview smokers who decide not to join the Stop Smoking Programme if further funding is obtained. Cheek swabs and saliva samples will be taken at baseline and to determine smoking status at 6 months from the set quit date. Genetic predictors of successful cessation (nicotine metabolism and DNA profiles) may also be explored as we will have the DNA to enable this, subject to further funding. We will make this clear on the consent forms.  We will undertake detailed analysis of transcripts of informative consultations using a special conversation analysis technique to Identify strategies to promote recruitment to smoking cessation services and provide effective support during the quit attempt.

PHASE 3: Development of an educational programme for pharmacists.

The systematic reviews and qualitative work will feed directly into development of the educational intervention. The framework for the intervention is likely to be PACE methodology which we used successfully previously to promote effective use of medication for treatment of asthma. Elements of effective interventions identified in the reviews will be added eg motivational interviewing. The interention will be tested in a pilot study in East London.

PHASE 4: A randomised controlled trial to evaluate effectiveness and cost effectiveness of  the educational intervention in practice. 

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