Evaluation of a Pharmacist and Nurse Practitioner Smoking Cessation Program.

PURPOSE: To evaluate the efficacy of a smoking cessation program led by a pharmacist and a nurse practitioner. METHODS: During a 6-month period, patients attended 7 one-on-one face-to-face smoking cessation counseling sessions with a pharmacist and 1 to 2 one-on-one face-to-face smoking cessation counseling sessions with a nurse practitioner. The primary outcome was smoking cessation point prevalence rates at months 1, 3, and 5 post-quit date. Secondary outcomes included medication adherence rates at months 1, 3, and 5 post-quit date, nicotine dependence at baseline versus program end, and patient satisfaction. RESULTS: Nine (47%) of 19 total participants completed the program. Seven of the 9 patients who completed the program were smoke-free upon study completion. Point prevalence rates at months 1, 3, and 5 post-quit date were 66%, 77%, and 77%, respectively, based on patients who completed the program. Medication adherence rates were 88.6%, 54.6%, and 75% at months 1, 3, and 5 post-quit date, respectively. Based on the Fagerstrom test, nicotine dependence decreased from baseline to the end of the study, 4.89 to 0.33 ( P < .001). Overall, participants rated the program highly. CONCLUSION: A joint pharmacist and nurse practitioner smoking cessation program can assist patients in becoming smoke-free.

Evaluation of a pharmacist-led, 6-month weight loss program in obese patients.

OBJECTIVE: To evaluate a pharmacist-led weight loss program based on the general requirements set forth by the Centers for Medicare & Medicaid Services' (CMS) Decision Memo for Intensive Behavioral Therapy for Obesity. SETTING: Onsite Walgreens pharmacy located inside the main administration building of Maricopa County in downtown Phoenix, AZ. PRACTICE DESCRIPTION: A prevention and wellness behavioral therapy weight loss program was developed for patients of the Maricopa County on-site Walgreens. PRACTICE INNOVATION: Current pharmacy patients were recruited to attend 14 one-on-one, pharmacist-led, face-to-face behavioral therapy sessions during a 6-month period that addressed diet, exercise, and nutrition. Interactive PowerPoint presentations were used throughout the sessions. MAIN OUTCOME MEASURES: The primary outcome was mean weight loss from baseline to the end of the study. Secondary outcomes included changes in body composition, changes in nutritional intake, and participant satisfaction. RESULTS: Of 12 enrolled participants, 11 (92%) completed the program. The mean weight loss from baseline to the end of the program was 5 kg (P <0.001), representing an average 4.5% weight loss. There was a statistically significant decrease in body mass index (BMI), waist circumference, and percent visceral fat from baseline to the end of the study; however, the increase in percent muscle mass, decrease in percent body fat, and change in nutrition intake was not statistically significant. Overall, the participants rated the program highly. CONCLUSION: Pharmacists are accessible health care providers who can effectively provide intensive behavioral therapy for obesity in a manner consistent with the CMS guidelines.

Safety of varenicline in patients with cardiovascular disease.

Smoking cessation lowers the risk of death substantially in patients with cardiovascular disease. Although varenicline is an effective medication for smoking cessation, its safety in this population has been questioned and evaluated in several studies. In 2 randomized controlled trials of patients with cardiovascular disease, the rates of serious cardiovascular events were up to 2% higher in patients receiving varenicline than placebo, though the differences were not statistically significant. In the first meta-analysis of mostly trials involving patients with a history of cardiovascular disease, varenicline was found to significantly increase the risk of cardiovascular events by 72%; however, a second meta-analysis did not find a significant increased risk. In an observational study, varenicline was not associated with an increased risk of events when compared to bupropion in a subgroup analysis of patients with a history of cardiovascular disease. Because the evidence on the safety of varenicline in this population is limited and conflicting, additional data are needed to formulate stronger conclusions. In the meantime, health care professionals should consider individual smoking patterns, concomitant medical conditions, and cost when recommending smoking cessation pharmacotherapy for patients with cardiovascular disease.