Beaupre Lauren A, Hammal Fadi, Stiegelmar Robert, Masson Edward, Finegan Barry
Department of Physical Therapy, University of Alberta, Edmonton, Canada.
Department of Surgery, University of Alberta, Edmonton, Canada.
Tob Induc Dis. 2020 Sep 14;18:78. doi: 10.18332/tid/126405. eCollection 2020.
We compared smoking cessation outcomes between those who used a pharmacist-led community-based smoking cessation intervention and those who did not, prior to total joint replacement (TJR) surgery. Also, we examined intervention characteristics (e.g. number/duration of sessions attended, recommended therapy) and smoking cessation outcomes.
This prospective evaluation was nested within a comparative study from a centralized clinic that prepares over 3000 patients annually for TJR and focused on participants referred to the community-based smoking cessation program preoperatively. Pharmacists offered an individualized evidence-based intervention and collected visit, duration and intervention data. Smoking cessation, the primary outcome, was ascertained independently of participating pharmacists at 6 weeks post-operative using exhaled CO monitoring and at 6 months post-recruitment via telephone interview.
Of 286 eligible candidates, 104 agreed to participate, with one subsequently withdrawing (n=103). At 6 weeks post-operatively, 66/103 (64%) participants returned for study re-assessment while 63/103 (61%) participants completed the post-recruitment interview at 6 months; non-respondents to study follow-up were considered smokers. Of 103 participants, 58 (56%) consulted with a pharmacist; those who did not consult a pharmacist (n=45) were slightly younger (p=0.02) with significantly higher CO level (p=0.02) on study entry. Validated 7-day point prevalence abstinence (PPA) at 6 weeks post-operative was 11/58 (19%) in pharmacist-compliant participants compared to 2/45 (4%) in non-compliant participants (p=0.04). At 6 months post-recruitment, 19/58 (33%) pharmacistcompliant participants self-reported a 7-day PPA compared to 2/45 (4%) by non-compliant participants (p<0.001). For pharmacist-compliant participants, 33/58 (54%) saw the pharmacist 4 times; the mean overall pharmacist time was 71.8±24.4 minutes/patient with 26/58 (45%) and 19/58 (33%) prescribed nicotine replacement therapy and varenicline, respectively, and 13/58 (22%) not using medication; post hoc analysis suggested varenicline was marginally more effective for smoking cessation than no medication (p=0.04).
Community-based pharmacist-led smoking cessation programs are an effective addition to usual preoperative care for smokers awaiting elective TJR. Using existing community resources led to higher smoking cessation rates in smokers waiting for TJR relative to those not using these resources.
我们比较了在全关节置换（TJR）手术前使用由药剂师主导的社区戒烟干预措施的人群与未使用该措施的人群的戒烟效果。此外，我们还研究了干预措施的特点（如参加的疗程数量/时长、推荐的治疗方法）和戒烟效果。
这项前瞻性评估嵌套在一项来自集中诊所的比较研究中，该诊所每年为超过3000名患者准备TJR手术，重点关注术前被转介到社区戒烟项目的参与者。药剂师提供个性化的循证干预措施，并收集就诊、时长和干预数据。戒烟是主要结局指标，在术后6周通过呼出一氧化碳监测独立于参与的药剂师进行确定，并在招募后6个月通过电话访谈确定。
在286名符合条件的候选人中，104人同意参与，其中1人随后退出（n = 103）。术后6周，66/103（64%）的参与者返回进行研究重新评估，而63/103（61%）的参与者在6个月时完成了招募后访谈；未对研究随访做出回应的人被视为吸烟者。在103名参与者中，58人（56%）咨询了药剂师；未咨询药剂师的人（n = 45）在研究开始时年龄稍小（p = 0.02），一氧化碳水平显著更高（p = 0.02）。在术后6周，符合药剂师指导的参与者中经验证的7天点患病率戒烟率（PPA）为11/58（19%），而不符合的参与者中为2/45（4%）（p = 0.04）。在招募后6个月，符合药剂师指导的参与者中有19/58（33%）自我报告7天PPA，而不符合的参与者中为2/45（4%）（p < 0.001）。对于符合药剂师指导的参与者，33/58（54%）见过药剂师4次；药剂师的平均总服务时间为71.8±24.4分钟/患者，分别有26/58（45%）和19/58（33%）的参与者被开具尼古丁替代疗法和伐尼克兰，13/58（22%）未使用药物；事后分析表明，伐尼克兰在戒烟方面比不使用药物略有效（p = 0.04）。
由药剂师主导的社区戒烟项目是等待择期TJR手术的吸烟者常规术前护理的有效补充。利用现有社区资源使等待TJR手术的吸烟者的戒烟率高于未使用这些资源的吸烟者。
