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Pharmacist-Led Tobacco Cessation Service Implementation Resources

Why Offer a Tobacco Cessation Program

The effects of tobacco use are multifold and have far-reaching impact on both smokers as well as those exposed to second-hand smoke. Seventeen percent of the population in Wisconsin uses tobacco.1 A 2015 University of Wisconsin-Milwaukee analysis of impact in Wisconsin reported tobacco-related illnesses cause approximately 7,000 deaths each year in Wisconsin.2 The report also estimates a 4.6-billion-dollar economic burden of smoking in Wisconsin from 2008 to 2012 due to the increased health care costs and cost of lost productivity.2

Pharmacists are well-positioned and trained to provide tobacco cessation services and can greatly contribute to the efforts to reduce tobacco use in Wisconsin. A 2013 meta-analysis on the pivotal impact community pharmacists have on tobacco cessation interventions found that both short- and long-term smoking cessation efforts were more successful when they were pharmacist-led.3 These community pharmacist interventions demonstrated better abstinence than the Quit Line alone (RR 2.21, 95% CI 1.49-3.29).3

A survey of Wisconsin pharmacists demonstrated the interest and opportunity for pharmacist-provide tobacco cessation services. Eighty-eight percent of pharmacists believe tobacco cessation counseling is an appropriate service to provide, 89 percent believe it is their professional responsibility to provide, and 94 percent were interested, very interested, or neutral in providing. Most pharmacists would provide services if they could attain a collaborative practice agreement and more would through a statewide standing order. Sixty percent of pharmacists believed little or no reimbursement is available for service provision and 68 percent said the addition of reimbursement would increase their motivation to provide services.4

Pharmacists believe it is their responsibility to provide tobacco cessation services to their patients and are interested in investing their time and expertise to help patients who are motivated and engaged. To support these professional services, scope of practice and financial sustainability models must be improved. Pharmacists show interest in providing tobacco cessation services through a collaborative practice agreement or a statewide standing order. The implementation of a toolkit with supplemental, non-medication related information about tobacco cessation service provision demonstrated improved pharmacist confidence in educating on tobacco cessation, financial sustainability models for pharmacist-provided tobacco cessation services, and motivational interviewing techniques. This toolkit will aid pharmacists in creating a business case for tobacco cessation services (patient access, quality metrics, reimbursement, other states’ programs).

References:

  1. Rankings. County Health Rankings & Roadmaps. http://www.countyhealthrankings.org/app/wisconsin/2016/measure/factors/9/map. Accessed May 30, 2018.
  2. Palmersheim KA, Prosser EC. Burden of Tobacco in Wisconsin: 2015 Edition. University of Wisconsin-Milwaukee, Center for Urban Initiatives and Research, Milwaukee, WI: 2015. http://uwm.edu/cuir/wp-content/uploads/sites/111/2015/04/Burden-of-Tobacco-2015.pdf Accessed May 30, 2018
  3. Saba M, Diep J, Saini B, Dhippayom T. Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. Advances in pediatrics. https://www.ncbi.nlm.nih.gov/pubmed/24749899. Published June 2014. Accessed May 30, 2018.
  4. Trapskin K, Martin E, Good J, McClelland H. Knowledge, confidence, and motivations of pharmacists in providing tobacco cessation services. 2018.

Financial Sustainability

To make tobacco cessation service provision financially sustainable, pharmacists can use incident fee, facility fee, contracts with employer wellness programs, and WPQC for those that qualify through Medicaid or United Way Dane County (this would be paired with a CMR and/or follow up visit). Reference UW-CTRI’s Medicaid and Tobacco Dependence Treatment facts sheet.
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