Optimising Pharmacist-Based Treatment for Smoking Cessation (STOP): a cluster randomised pilot controlled trial of training inte

Problem

Title: Optimising Pharmacist-Based Treatment for Smoking Cessation (STOP): a cluster randomised pilot controlled trial of training interventionThe Problem:Smoking causes around 100,000 deaths annually in the UK and is a major cause of cardiovascular disease, chronic respiratory disease and cancer. Since 2008 government policy has been to strengthen primary care delivery through the pharmacies in a wide range of medical conditions including smoking cessation. Quit rates in this setting is however lag behind to those seen in specialist services. Currently there is little evidence to guide optimal smoking cessation strategies for community pharmacies. The overall aim of this pilot trial is to establish the potential impact of a complex intervention to promote uptake and effectiveness of smoking cessation services, and to optimise logistics for conducting a future definitive trial.

Approach

This is a cluster randomised parallel group pilot trial. There were two groups of trial participants 1) community pharmacies/stop smoking advisors and 2) service users. Twelve community pharmacies were allocated to STOP educational intervention or standard training (allocation ratio 2:1) using simple randomisation. Our primary outcome was the number of service users enrolling in the smoking cessation programme. Our secondary outcome was retention and quit rates amongst those enrolled in the service who agreed to provide appropriate data. Data were analysed descriptively, using means, ranges, numbers, proportions, and confidence intervals as appropriate.

Findings

Smoking advisor and pharmacy participation rates were 87.0% (95% CI: 66.4% to 97.2%) and 22.2% (95% CI: 12.0% to 35.6%) respectively. 302 service users were enrolled in the smoking cessation service in intervention pharmacies (average per pharmacy 43.14, 95% CI: -4.26 to 90.54) and 319 in ’usual practice’ pharmacies (average per pharmacy 79.75, 95% CI: 18.97 to 140.53). 24 of 32 consented service users were retained at four weeks in the usual practice arm (75.0%, 95%CI: 56.6% to 88.5%) and 17 of 19 in the STOP intervention arm (89.5%, 95%CI: 66.9% to 98.7%). Seven of 32 in standard training arm had stopped smoking, confirmed by exhaled carbon monoxide (21.9%, 95%CI: 9.3% to 40.0%) compared to 10 of 19 in the STOP intervention arm (52.6%, 95%CI: 28.9% to 75.6%).

Consequences

This pilot trial indicates that the STOP intervention could influence service user engagement and improve retention in stop smoking services, and provided insights on how best to conduct the definitive trial. We have successfully resolved the difficulties encountered in conducting the pilot trial. Now preparations are under way to progress with the definitive trial.