Smoking cessation - The contribution of community pharmacy

Smoking accounts for significant morbidity and mortality and has major economic consequences for healthcare delivery throughout the world. Government policy such as increasing taxes and restricting advertising go some way to reduce smoking,but the social and economic factors that affect target populations will impact on the success of any strategy. Public health interventions can also contribute to increasing cessation rates. The most successful interventions appear to be those characterised by personalised advice and assistance, repeated in different forms over the longest feasible period of time. Pharmacological aids, which are important components of a cessation programme, include nicotine replacement therapy in the form of chewing gum, patches, nasal spray, oral inhaler or sublingual tablets; bupropion (amfebutamone) has been approved for use in some countries. As the community pharmacy is the major point of supply of such products, the pharmacist is in a key position to encourage and support clients who wish to stop smoking. A number of studies have examined the role of the community pharmacist in assisting smokers through the so-called 'cycle of change'. These studies have utilised a model that offers individualised advice through a motivational technique to encourage a change in behaviour; nicotine replacement therapy is optional. Follow-up is an essential part of these programmes to monitor progress and to provide additional support. Evaluations of these pharmacy-based initiatives have confirmed the importance of a multifaceted approach in achieving success in smoking cessation, i.e. behaviour modification, nicotine replacement therapy and client support.