Deshabituación al consumo de tabaco desde las oficinas de farmacia mediante planes multidisciplinares / Smoking cessation from pharmacies through multidisciplinary plans

Fundamentos: El tabaco es la droga más consumida en el mundo y cada año provoca la muerte de más de ocho millones depersonas. El farmacéutico es el profesional de la salud más accesible a los fumadores, por lo que es fundamental en el tratamientoy prevención del tabaquismo. El objetivo de este estudio fue implantar un programa antitabaco multidisciplinar en una oficina defarmacia y evaluar el efecto de la atención farmacéutica en la cesación del consumo de tabaco. Métodos: El estudio se realizó en dos farmacias del Ejército de Tierra situadas en España y Líbano en las que se desarrolló unplan de deshabituación al consumo de tabaco durante los años 2020 y 2021. Como criterio de selección de participantes se aceptó atodos aquellos pacientes del área de influencia de las farmacias que aceptasen participar en el programa, siendo el tamaño muestralde treinta y ocho personas. Los pacientes se sometieron a test de adicción, motivación y hábito de consumo de tabaco, y se realizóun análisis descriptivo de los datos aportados, usando el test de chi-cuadrado para la comparación de valores, considerándoseestadísticamente significativos solo aquellos con un valor de probabilidad inferior a 0,05. Resultados: El trabajo multidisciplinar permitió el tratamiento con medicamentos mediante prescripción médica. El 63% de lospacientes del estudio consiguieron dejar de fumar. Conclusiones: Las oficinas de farmacia pueden implantar y liderar programas de deshabituación al consumo de tabaco quefaciliten la cesación y la adhesión a los tratamientos. La clasificación de los pacientes según su historial de tabaquismo resulta clavepara realizar un tratamiento adecuado y personalizado.(AU)

Background: Tobacco is the most consumed drug in the world and each year it causes the death of more than eight millionpeople. The pharmacist is the healthcare professional most accessible to smokers, therefore they are essential in the treatment andprevention of smoking. The study´s aim was to implement a multidisciplinary anti-smoking program in a pharmacy and evaluate theeffect of pharmaceutical care on smoking cessation. Methods: The study was carried out in two army pharmacies located in Spain and Lebanon in which a smoking cessation plan wasdeveloped in 2020 and 2021. As the requirements for participants selection, all those patients in the area of influence of pharmaciesthat agreed to participate in the program were accepted, with a sample size of thirty-eight people. The patients underwent an addiction,motivation and smoking habit test, and a descriptive analysis of the data provided was carried out, using the chi-square test for thecomparison of values. Only those with a probability value less than 0.05 are considered statistically significant.Results: The multidisciplinary work allowed treatment with prescription drugs. The study shows that 63% of patients managedto quit smoking. Conclusions: Pharmacies can implement and lead smoking cessation programs that facilitate cessation and adherence to treat-ments. The classification of patients according to their history of smoking is key to carrying out an adequate and personalized treatment.(AU)

Estudio comparativo de efectividad entre la Hipnosis y la intervención Cognitivo-Conductual para la Deshabituación Tabáquica / Comparative study of effectiveness between Hypnosis and Cognitive-Behavioral intervention for Smoking Cessation

Introducción: El consumo de tabaco es la primera causa de muerte evitable. A muchos fumadores les gustaría dejar el hábito. Aun así, a pesar de la eficacia demostrada de las intervenciones, muchos no están dispuestos a realizar un intento debido a las altas tasas de recaída y al miedo a los efectos secundarios de los tratamientos empleados, inclinándose a probar métodos alternativos.Objetivo: Conocer si la intervención avanzada individual (multicomponente cognitiva-conductual) es más efectiva que la intervención con hipnoterapia en pacientes fumadores, como tratamiento para dejar de fumar.Metodología: Estudio cuasiexperimental. Se incluyeron pacientes fumadores con antecedentes de patología respiratoria. Fueron asignados, según su preferencia, a un grupo de intervención avanzada individual en tabaquismo (grupo A) - al que se realizó una terapia multicomponente para dejar de fumar- o a un grupo de hipnoterapia (grupo B) en el que se realizó hipnosis para dejar de fumar.Todos los pacientes recibieron el tratamiento farmacológico y las pautas de actuación habituales que se utilizan en las consultas externas para tratar la enfermedad.Resultados: Se encontraron diferencias significativas en la cesación del consumo de tabaco a los 6 meses, encontrándose valores inferiores tanto en el abandono como en la disminución del consumo en los pacientes a los que se les realizó hipnoterapia versus terapia multicomponente (p 0,023 y p 0,031 respectivamente). Conclusiones: La intervención para el abandono del tabaco que incorpora la hipnosis no ha demostrado ser tan eficaz como la terapia multicomponente en la población estudiada. (AU)

Introduction: Tobacco use is the number one preventable cause of death. Many smokers would like to kick the habit. Still, despite the proven efficacy of the interventions, many are reluctant to try due to high relapse rates and fear of side effects of the treatments used, and are inclined to try alternative approaches.Objetive: To know if the individual advanced intervention (cognitive-behavioural multicomponent) is more effective than the intervention with hypnotherapy in smokers, as a treatment to quit smoking.Methodology: Quasi-experimental study. Smokers with a history of respiratory pathology were included. They were assigned, according to their preference, to an advanced individual smoking cessation intervention group (group A) - which underwent multicomponent therapy to quit smoking - or to a hypnotherapy group (group B) in which hypnosis was performed to quit smoking. of smoking.All patients received the pharmacological treatment and the usual action guidelines that are used in outpatient clinics to treat the disease.Results: Significant differences were found in the cessation of tobacco consumption at 6 months, with lower values both in quitting and in the reduction of consumption in patients who underwent hypnotherapy versus multicomponent therapy (p 0.023 and p 0.031, respectively).Conclusions: Smoking cessation intervention incorporating hypnosis has not been shown to be as effective as multicomponent therapy in the population studied. (AU)

Cost-effectiveness of real-world administration of tobacco pharmacotherapy in the United States Veterans Health Administration.

BACKGROUND AND AIMS: Cost-effectiveness studies in randomized clinical trials have shown that tobacco cessation pharmacotherapy is among the most cost-effective of health-care interventions. Clinical trial eligibility criteria and treatment protocols may not be followed in actual practice. This study aimed to determine whether tobacco cessation pharmacotherapy is cost-effective in real-world settings. DESIGN: A retrospective analysis of costs and outcomes. SETTING: Hospitals and clinics of the US Veterans Health Administration, USA. PARTICIPANTS: A total of 589 862 US veterans who screened positive for tobacco use in 2011. INTERVENTION AND COMPARATOR: Tobacco users who initiated smoking cessation pharmacotherapy in the 6 months after screening were compared with those who did not use pharmacotherapy in this period. Pharmacotherapy included nicotine replacement therapy, bupropion (if prescribed at 300 mg per day or specifically for tobacco cessation) or varenicline. MEASURES: Effectiveness was determined from responses to a subsequent tobacco screening conducted between 7 and 18 months after the treatment observation period. Cost of medications and prescribing health-care encounters was determined for the period between initial and follow-up tobacco use screening. Multivariate fixed-effects regression was used to assess the effect of initial treatment status on cost and outcome while controlling for differences in case-mix with propensity weighting to adjust for confounding by indication. FINDINGS: Thirteen per cent of participants received tobacco cessation pharmacotherapy within 6 months of initial screening. After an average of an additional 218.1 days' follow-up, those who initially received pharmacotherapy incurred $143.79 in additional treatment cost and had a 3.1% absolute increase in tobacco quit rates compared with those who were not initially treated. This represents an incremental cost-effectiveness ratio of $4705 per quit. The upper limit of the 99.9% confidence region was $5600 per quit. Without propensity adjustment, the cost-effectiveness ratio was $7144 per quit, with the upper limit of the 99.9% confidence region $9500/quit. CONCLUSIONS: Tobacco cessation pharmacotherapy provided by the US Veterans Health Administration in 2011/12 was cost-effective in this real-world setting, with an incremental cost-effectiveness ratio of $4705 per quit.

Tobacco Use Prevalence and Smoking Cessation Pharmacotherapy Prescription Patterns Among Hospitalized Patients by Medical Specialty.

INTRODUCTION: Effective smoking cessation medications are readily available but may be underutilized in hospital settings. In our large, tertiary care hospital, we aimed to (1) characterize patient tobacco use prevalence across medical specialties, (2) determine smoking cessation pharmacotherapy prescription variation across specialties, and (3) identify opportunities for improvement in practice. METHODS: Using electronic health records at Barnes Jewish Hospital, we gathered demographic data, admitting service, admission route, length of stay, self-reported tobacco use, and smoking cessation prescriptions over a 6-year period, from 2010 to 2016. We then compared tobacco use prevalence and smoking cessation prescriptions across medical specialties using a cross-sectional, retrospective design. RESULTS: Past 12-month tobacco use was reported by patients in 27.9% of inpatient admissions; prescriptions for smoking cessation pharmacotherapy were provided during 21.5% of these hospitalizations. The proportion of patients reporting tobacco use was highest in psychiatry (55.3%) and lowest in orthopedic surgery (17.1%). Psychiatric patients who reported tobacco use were most likely to receive pharmacotherapy (71.8% of admissions), and plastic surgery patients were least likely (4.7% of admissions). Compared with Caucasian tobacco users, African American patients who used tobacco products were less likely to receive smoking cessation medications (adjusted odds ratio [aOR] = 0.65; 95% confidence interval [CI] = 0.62 to 0.68). CONCLUSIONS: Among hospitalized tobacco users, safe and cost-effective pharmacotherapies are under-prescribed. We identified substantial variation in prescribing practices across different medical specialties and demographic groups, suggesting the need for an electronic medical record protocol that facilitates consistent tobacco use cessation pharmacotherapy treatment. IMPLICATIONS: Tobacco use cessation pharmacotherapy is underutilized during hospitalization, and prescription rates vary greatly across medical specialties and patient characteristics. Hospitals may benefit from implementing policies and practices that standardize and automate the offer of smoking pharmacotherapy for all hospitalized patients who use tobacco.

A quasi-experimental study examining New York State's tobacco-free regulation: effects on clinical practice behaviors.

BACKGROUND: On July 24, 2008, New York State (NYS) became the first state to require all state-funded or state-certified substance use disorder (SUD) treatment organizations to be 100% tobacco-free and offer tobacco cessation (TC) treatment. METHODS: The current study used a quasi-experimental, non-equivalent control group design with a pretest and posttest to examine the effect of the NYS tobacco-free regulation on three clinical practice behaviors (use of TC-related intake procedures, use of guideline recommended counseling for TC, and pharmacotherapy availability) in a diverse sample of SUD treatment programs. Repeated cross-sectional data were collected from NYS counselors (experimental group) and non-NYS counselors (control group) approximately 4 months pre-regulation (N=282 and 659, respectively) and 10-12 months post-regulation (N=364 and 733, respectively). RESULTS: Using mixed-effects models, results at pre-regulation indicate no group differences in the three clinical practice behaviors. However, significant post-regulation effects were found such that the experimental group reports greater use of TC-related intake procedures, guideline recommended counseling, and availability of pharmacotherapy than the control group. Additionally, the experimental but not the control group shows increases in all three clinical practice behaviors from pre-regulation to post-regulation. CONCLUSIONS: We conclude that the NYS tobacco-free regulation had a significant and positive effect on promoting patient TC efforts among counselors.