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Effectiveness of pharmacist counseling combined with nicotine replacement therapy: a pragmatic randomized trial with 6,987 smokers

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Abstract

Pharmacists may be effective health care practitioners to deliver smoking cessation interventions. This paper examines the short-term outcomes of smokers randomized to one of two models of a pharmacist-led smoking cessation intervention. Methods: An open-label pragmatic randomized trial compared two models of a pharmacist-led behavioral intervention [Group A (3-sessions) vs. Group B (1-session)] in conjunction with 5 weeks of nicotine replacement therapy (NRT). Ninety-eight pharmacies in Ontario, Canada delivered the intervention. Baseline demographic and smoking behavior data were recorded, as were intervention characteristics. Self-reported, 7-day point prevalence quit rates were obtained 5-week postintervention start date. Results: 6,987 individuals participated; 51.4% (n = 3588) randomized to Group A; 48.6% (n = 3399) to Group B. Approximately, 50% of Group A participants completed all three sessions. Quit rates were significantly higher among Group A, 3-session completers (27.7%; n = 478) compared to Group B participants (18.0%; n = 604). Multivariable results suggest that even when controlling for possible confounders and clustering across pharmacies, Group A participants who completed all three sessions were more likely to quit compared to Group B [OR = 1.72 (95% CI: 1.53, 1.94)]. Conclusions: Cessation outcomes are higher among participants completing three intervention sessions compared to one session; however, many do not return for follow-up sessions.

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Notes

  1. Formula for calculating in the intraclass correlation (ICC) for binary outcomes, where \( {\text{ICC}} = {\frac{{\sigma_{{\mu_{0} }}^{2} }}{{\sigma_{{\mu_{0} }}^{2} + \pi^{2} /3}}} \)

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Acknowledgments

The STOP Study was funded by the Ontario Ministry of Health Promotion (awarded to P. Selby) and conducted by research staff at the Nicotine Dependence Clinic, Centre for Addiction and Mental Health (Toronto) and 113 pharmacists across Ontario who graciously volunteered their time. The Ontario Pharmacist Association assisted with recruiting pharmacists. The authors are extremely grateful of the assistance provided by the project manager Rosa Dragonetti and research assistants Lauren Tribe, Sari Goldstein, Bianca Filoteo and the research team. The findings and opinions do not reflect those of the funding agencies, partners nor employers of any investigator.

Conflicts of interest

The authors would like to declare the following:

B. Sproule has received grant funding from Health Canada, the Canadian Institutes of Health Research (CIHR), Canadian Tobacco Control Research Initiative (CTCRI) and the Whitaker Foundation.

L. Zawertailo has received funding from Health Canada, CIHR and the CTCRI. She is a co-investigator on peer-reviewed and industry-initiated grants by Pfizer Inc and Johnson and Johnson and has received honoraria from Pfizer Canada.

J. C. Victor has received grant funding from the CTCRI and CIHR.

P. Selby has received grant funding from National Institute on Drug Abuse (NIDA), CIHR, CTCRI, Health Canada and the Ontario Ministry of Health Promotion. He has also received consulting and or speaker fees from the following manufacturers of smoking cessation medication—Pfizer Inc, Johnson and Johnson (J&J), Sanofi-Synthelabo. NRT for this study was purchased by CAMH using a tendering process. J&J provided the NRT at a discount roughly equivalent to wholesale prices in Canada. They had no role in the design or conduct of the study.

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Authors and Affiliations

  1. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Mary Jean Costello, Beth Sproule, Laurie Zawertailo & Peter Selby

  2. Faculty of Pharmacy and Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Beth Sproule

  3. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    J. Charles Victor, Scott T. Leatherdale & Peter Selby

  4. Department of Population Studies and Surveillance, Cancer Care Ontario, Toronto, ON, Canada

    Scott T. Leatherdale

  5. Centre for Behavioral Research and Program Evaluation, Canadian Cancer Society, Waterloo, ON, Canada

    Scott T. Leatherdale

  6. Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada

    Laurie Zawertailo

  7. Department of Family and Community Medicine and Psychiatry, University of Toronto, Toronto, ON, Canada

    Peter Selby

  8. Ontario Tobacco Research Unit, Toronto, ON, Canada

    Peter Selby

  9. Addictions Program, Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada

    Peter Selby

Authors
  1. Mary Jean Costello
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  2. Beth Sproule
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  3. J. Charles Victor
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  4. Scott T. Leatherdale
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  5. Laurie Zawertailo
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  6. Peter Selby
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Correspondence to Peter Selby.

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Costello, M.J., Sproule, B., Victor, J.C. et al. Effectiveness of pharmacist counseling combined with nicotine replacement therapy: a pragmatic randomized trial with 6,987 smokers. Cancer Causes Control 22, 167–180 (2011). https://doi.org/10.1007/s10552-010-9672-9

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  • DOI: https://doi.org/10.1007/s10552-010-9672-9

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