Provision of Smoking Cessation Services in Australian Community Pharmacies: a Simulated Patient Study

Background: With the rising interest in expanding pharmacists' role in smoking cessation, it is pertinent that community pharmacists be equipped with up-to-date knowledge and competence to provide optimal therapeutic services that meet the demands of various presenting subsets of smokers.

Objective: To investigate and evaluate responses to requests of quitting smoking from 'high risk' smokers seeking assistance and treatment within the pharmacy venue.

Setting: Community pharmacies located within Sydney greater metropolitan area, New South Wales, Australia.

Method: A simulated patient methodology was utilised. Two scenarios were developed and enacted by two trained simulated patients in 100 randomly selected pharmacies. Scenario 1 involved a 28-year-old pregnant female who presents with a request for help in quitting smoking. Scenario 2 involved a 22-year-old female requesting a quit smoking product for her 55-year-old father who has cardiovascular problems. A standardised scoring key was designed to assess the performance of pharmacists during each encounter.

Main Outcome Measure: The primary outcome measure was the supply/non-supply of nicotine replacement products and the corresponding provision of counselling and advice to facilitate smoking cessation.

Results: A product(s) was supplied in 42 % of the 100 encounters, while a product was adequately suggested pending doctor's referral in 45 %. In 13 % of the cases, a product was not supplied based on inappropriate notions of nicotine replacement therapy not being safe in the presented scenario. Pharmacists performed better in dispensing scores (counselling about product use) as compared to pre-dispensing scores (eliciting patient history). ANOVA followed by regression analysis indicated that the estimated age and gender of the pharmacist/staff were significant predictors affecting total scores.

Conclusion: Whilst pharmacists' counselling about smoking cessation aids seems satisfactory, further education is required to improve practice standards in terms of matching a patient's history and smoking status to an appropriate product.