The Perfect Pairing

This is a bit of a follow up to a previous post of mine. I promised it would be a work in progress! I think it is time to build on the concept of pharmacist led smoking cessation.

There are numerous collaborative practice agreements out there. One that we could specifically model after is the anticoagulation protocol. Have your local physician sign with an agreement with you. Use the protocol to dispense appropriate therapy. Monitor and check in with patient throughout course. Bill as a medication therapy management claim. Simple. You may say well no one is doing it? If we continue to wait for others to tell us how to care for our patients we will surely be left out of any decision making!

I cannot tell you how many times I see prescriptions for Nicotine Replacement Therapy (NRT) and non nicotine products (Chantix or Zyban) that come across the pharmacy counter to only be “put on hold” or “returned to stock”. Why is this? What are the factors contributing to this first step failure? I think many patients do not like the cost. I will say many insurances are now covering these options (as they should be). We are in the preventative healthcare model right? IF the factor is still cost…find a coupon for them or assistance. In Louisiana specifically there is a trust fund that will cover Chantix or NRT therapy and provides additional resources at no cost to the patient. Most do not know about this. Other states offer similar such programs.  As a pharmacist ask the question! You might find you can alleviate some financial burden. Another reason is fear of side effects. The patient may agree to take the prescription from the prescriber to only then be overcome with fear of negative information such as vivid dreams or mood disorders. Be the clear voice. Provide them with directed education and let them know you are always available for additional questions once they get home!

We know our patients. The CDC has done a great job with their tips from former smokers campaign. I think the reason it is so effective is because it is personal. It speaks directly to people. Smokers associate smoking with every thing in their life. One former smoker told me she felt like she lost her best friend. We need to connect with our patients on this level. How can we give them a patch or gum or medication, a pat on the back, wish them luck and expect a complete lifestyle change? Where is the continued support?

The CDC also confirmed the following treatments are proven to be effective for smokers who want help to quit:
• Brief help by a doctor (such as when a doctor takes 10 minutes or less to give a patient advice and assistance about quitting)
• Individual, group, or telephone counseling
• Behavioral therapies (such as training in problem solving)
• Treatments with more person-to-person contact and more intensity (such as more or longer counseling sessions)
• Programs to deliver treatments using mobile phones
Medications for quitting that have been found to be effective include the following:
• Nicotine replacement products
◦ Over-the-counter (nicotine patch [which is also available by prescription], gum, lozenge)
◦ Prescription (nicotine patch, inhaler, nasal spray)
• Prescription non-nicotine medications: bupropion SR (Zyban®), varenicline tartrate (Chantix®)
Counseling and medication are both effective for treating tobacco dependence, and using them together is more effective than using either one alone
• More information is needed about quitting for people who smoke cigarettes and also use other types of tobacco

It’s all there. Spelled out exactly from the experts. I especially like “counseling and medication are both effective”. You who…that’s us…community pharmacists! I believe the pharmacist is the ideal healthcare provider that can touch on each of those levels. And friends do not be afraid. I have been talking about this for some time now and the reception is quite warm. People like to hear what we are doing. They like to know we are thinking of ways to provide better care! Please contact me with thoughts!

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