Quit rates among smokers who received pharmacist-provided pharmacotherapy and quitline services versus those who received only quitline services.

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2 Quit rates among smokers who received pharmacist-provided pharmacotherapy and quitline services versus those who received only quitline services. Jill Augustine, PharmD, MPH 1 ; Ryan Seltzer, PhD 2 ; Martin Pelger, BSPharm, RPh 3 ; Kevin Boesen, PharmD 4 ; Terri Warholak, PhD, RPh 1 1 University of Arizona College of Pharmacy 2 University of Arizona Mel & Enid Zuckerman College of Public Health, ASHLine 3 University of Arizona College of Pharmacy Medication Management Center 4 SinfoníaRx 2

3 [FOR APHA USE ONLY] Supporter 3

4 Attendance Code [FOR APHA USE ONLY] To obtain CPE credit for this activity, you are required to actively participate in this session. The attendance code is needed to access the evaluation and CPE form for this activity. Your CPE must be filed by April 27, 2015 at 5:00 pm EDT in order to receive credit. 4

5 Disclosures Dr. Jill Augustine reports that she has stock in Pfizer, Inc., which markets for many of the smoking cessation products. All other faculty declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 5

6 Target Audience: [FOR APHA USE ONLY] ACPE#: [FOR APHA USE ONLY] Activity Type: [FOR APHA USE ONLY] 6

7 Learning Objectives 1. Summarize the impact of smoking cessation services on healthcare resource cost and utilization 2. Compare quit rates presented in previous literature 3. Discuss the quit rates for Arizona state employees who received pharmacotherapy smoking cessation counseling and/or telephone quit services 4. Outline key differences in the intent to treat and responder rate analyses 7

8 Which program had a significantly higher unadjusted quit rate for the responder rate analysis? a. Participants receiving the combined pharmacotherapy smoking cessation counseling plus telephone quitline services (Medication Management Center (MMC) participants). b. Participants receiving telephone quitline services only (Arizona Smoker s Helpline (ASHLine) participants). c. There were no significant differences observed between the two groups of participants. 8

9 Objective 1 Background Cigarette smoking is the leading cause of preventable disease and death in the U.S. 1 Approximately 42 million adults currently smoke cigarettes (~17.8%). 1 Annual economic costs of tobacco use exceed $289 billion. 2 Nearly 70% of current U.S. adult cigarette smokers want to quit completely. 3 Almost 53% attempt to quit once in the past year. 3 About 43% of all adult smokers stopped smoking for >1 day. 3 Multiple smoking cessation treatments are available including quitline services, nicotine replacement therapies, and prescription medications. 9

10 Objective 2 Background Quitline are beneficial in helping smokers quit. 4-6 Quit rates range from 6-27%, depending on the number of calls. 4 Pharmacist-provided programs are effective in helping smokers quit Quit rates range from 12-28%, depending on the program type Combined medication-plus-counseling programs are more effective (27.6%) in treating tobacco dependence than medication (21.7%) or counseling (14.6%) used alone

11 Methods Retrospective chart review Inclusion criteria Received services from University of Arizona Medication Management Center (UAMMC); Arizona Smokers Helpline (ASHLine); or both Completed a follow-up phone call to determine smoking cessation Initial enrollment prior to December 1, 2012 Completed a phone call with ASHLine Exclusion criteria Participant contacted either service to request smoking cessation information and not interested in quitting IRB approved project 11

12 Interventions Arizona Smokers Helpline (ASHLine) Free telephone and Webbased quit service Any resident of Arizona may contact trained personnel Personnel work with smokers Set goals Work towards a quit date Develop a personnel plan for quitting University of Arizona Medication Management Center (MMC) Offers pharmacotherapy smoking cessation support State of Arizona employees receive information about MMC in their medical insurance packages Patients can Access to pharmacotherapy treatment options at no cost Received scheduled counseling by pharmacists All patients who receive cessation services from MMC are referred to ASHLine 12

13 Methods Participants were matched on: Medication use Stage of Change Self-efficacy Education Quit success (30 days smoke-free) or failure was based on participants self-report. 13

14 Methods-Data Analysis Descriptive statistics used for baseline characteristics, current smoking habits and matching statistics. Chi-square test used for unadjusted quit rates. Generalized linear mixed model used for adjusted quit rates. 14

15 Results-Baseline characteristics 241 matched pairs ASHLine (n=241) MMC + ASHLine (n=241) Age, mean (SD) 50 (13) 52 (12) Female, n (%) 142 (59) 141 (59) Caucasian, n(%) 188 (78) 186 (77) Not Hispanic, n (%)* 184 (76) 206 (85) Some College Education, n (%)* 74 (31) 100 (41) *p-value<

16 Baseline smoking habits and attitudes ASHLine (n=241) MMC + ASHLine (n=241) Daily smokers, n (%) 233 (97) 225 (94) Number cigarettes per day, mean (SD) 18 (10) 18 (9) Currently using medications, n (%) Nicotine replacement therapy (NCRT) Prescription 19 (8) 16 (7) 19 (8) 16 (7) Want to quit within next 30 days, n (%) Yes No Don t know 226 (94) 4 (2) 11 (5) 226 (94) 4 (2) 10 (4) Confidence to quit with next 24 hours, n (%) (10) 18 (7) 28 (12) 45 (19) 119 (49) 21 (9) 17 (7) 33 (14) 44 (18) 125 (51) 16

17 Results-Unadjusted Quit rates Intent-to-treat analysis ASHLine (n=241) MMC + ASHLine (n=241) Quit, n (%) 47 (20) 43 (18) Did Not Quit, n (%) 81 (34) 42 (17) No response, n (%) 113 (47) 156 (65) Quit Rate 20% 18% p-value=0.64 Responder Rate ASHLine (n=128) Objectives 3, 4 MMC + ASHLine (n=85) Quit, n (%) 47 (37) 43 (51) Did Not Quit, n (%) 81 (63) 42 (49) Quit Rate* 37% 51% *p-value=

18 Objectives 3, 4 Results-Generalized Mixed Model No significant differences in quit rates for Intent-to-Treat (ITT) or Responder-rate (RR) between MMC+ASHLine and ASHLine participants. OR (95% CI) Intent-to-Treat analysis 1.13 ( ) Responder-rate analysis 0.56 ( ) P-value Controlled for: current medication use, stage of change (intention to quit in the next 30 days), ability to quit smoking for next 30 days (self-efficacy), and education 18

19 Limitations Non-randomized sample Baseline differences between groups Response bias Self-report Smoking stigma Large number of participants were lost to follow-up 19

20 Key Points First study comparing quit rates between a pharmacistdriven service and a quitline. Both interventions provide one-on-one support for smokers seeking help to quit. No significant differences observed between the groups for intent-to-treat analysis. Significant differences observed for responder rates for MMC+ASHLine participants (51%) versus ASHLine alone (37%). 20

21 References 1. Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults United States, Morbidity and Mortality Weekly Report 2014;63(47): [accessed 2015 Jan 29]. 2. U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Jan 29].. 3. Centers for Disease Control and Prevention. Quitting Smoking Among Adults United States, Morbidity and Mortality Weekly Report 2011;60(44): [accessed 2015 Jan 29]. 4. Stead LF, Hartmann-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2013; 8: CD doi: / CD pub3. 5. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May An LC, Schillo BA, Kavanaugh AM, Lachter RB, Luxenberg MG, Wendling AH, Joseph AM. Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tob Control. 2006;15: Sinclair HK, Bond CM, Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD DOI: / CD pub2. 8. Kennedy DT, Giles JT, Chang ZG, Small RE, Edwards JH. Results of a smoking cessation clinic in community pharmacy practice. J Am Pharm Assoc. 2002;42(1): Roth MT, Westman EC. Use of bupropion SR in a pharmacist managed outpatient smoking-cessation program. Pharmacotherapy. 2001;21(5): Sinclair HK, Bond CM, Lennox AS, Silcock J, Winfield AJ, Donnan PT. Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomized controlled trial in Scotland. Tobacco Control. 1998;7(3): Maguire TA, McElnay JC, Drummond A. A randomized controlled trial of a smoking cessation intervention based in community pharmacies. Addiction. 2001;96(2): Mdere ND, Chindove S. Effectiveness of tobacco use cessation interventions delivered by pharmacy personnel: A systematic review. Res Soc Admin Pharm. 2014;10(1):

22 Which program had a significantly higher unadjusted quit rate for the responder rate analysis? a. Participants receiving the combined pharmacotherapy smoking cessation counseling plus telephone quitline services (Medication Management Center (MMC) participants). b. Participants receiving telephone quitline services only (Arizona Smoker s Helpline (ASHLine) participants). c. There were no significant differences observed between the two groups of participants. 22

23 Attendance Code [FOR APHA USE ONLY] You will need this attendance code in order to access the evaluation and CPE form for this activity. Your CPE must be filed by April 27, 2015 at 5:00 pm EDT in order to receive credit. 23

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