PHARMACEUTICAL CARE PROVISION BY MALAYSIAN PHARMACISTS VIA SMOKING CESSATION SERVICES

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PHARMACEUTICAL CARE PROVISION BY MALAYSIAN
PHARMACISTS VIA SMOKING CESSATION SERVICES

• Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed
• Chief Coordinator of CSCSP Program
• Head, Pharmacy Practice Dept
• Kulliyyah of Pharmacy
• International Islamic University Malaysia (IIUM)
• 25200 Kuantan, Pahang
• haniki_at_iiu.edu.my

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MALAYSIA
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TOBACCO EPIDEMIC

• Cigarette smoking is the chief, single,
  avoidable cause of death in our society and the
  most important public health issue of our time
• Globally, 1.3 billion people are current smokers
  and about 650 million persons will die
  prematurely of tobacco-related disease.
• WHO MPOWER Report 2008

C. Everett Koop, M.D., former U.S. Surgeon
General Surgeon Generals report,1982
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Smoking Leading Preventable Cause of Disease and
Death1
Top 3 smoking-attributable causes of death. In
patients who are Helicobacter pylori
positive.AML Acute myeloid leukemia ALL
acute lymphocytic leukemia CLL chronic
lymphocytic leukemia COPD chronic obstructive
pulmonary disease SIDS sudden infant death
syndrome.1. Surgeon Generals Report. The Health
Consequences of Smoking 2004. 2. Sandler DP, et
al. J Natl Cancer Inst. 199385(24)1994-2003.
3. Crane MM, et al. Cancer Epidemiol Biomarkers
Prev. 19965(8)639-644. 4. Miligi L, et al. Am J
Ind Med. 199936(1)60-69. 5. Roman GC.
Cerebrovasc Dis. 200520(Suppl 2)91-100. 6.
Willigendael EM, et al. J Vasc Surg.
2004401158-1165.
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NHMS (1986, 1996, 2006)

• Current Adult Smokers in Malaysia

4 mil smokers in Malaysia consume average 14
cigarettes/day1
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Adult Smoking Prevalence
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Adolescent Smoking Prevalence (13 to lt18 years)
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Vision

• By 2020, tobacco will no longer be a major
  public health concern in Malaysia, where
  decreasing national prevalence of tobacco use is
  halved and tobacco attributed diseases and
  mortality will continuously decline

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FCTC Intersectoral collaboration capacity
building
Legislation

• Control of Tobacco Products Regulations
• Enforcement
• Draft Tobacco Control Act
• Other legislations (customs, etc)

• FCTC Steering Committee (FCTC Secretariat)
• Subcommittee
• Conference of Parties (COP)

National Tobacco Control Programme
Health Promotion Advocacy
National Quit Smoking Programme

• Tak Nak (Say No) Campaign
• Healthy Lifestyle Campaign
• Fresh Breath Beginning Ramadhan
• World No Tobacco Day
• Events by other agencies esp. NGOs

• Quit smoking clinics (HC hospitals)
• Quitline (test) CPG
• Certified Smoking Cessation Service Provider
  (CSCSP)
• Smoking cessation into curriculum

Research, Surveillance Evaluation
Tax Price Measures

• Tobacco tax increase
• Earmarked tobacco tax

• NHMS (I, II, III) other MOH studies
• C-Tob studies by other agencies

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• Prescribers (322 nurse practitioners,
  physicians, and physician assistants) and
  non-prescribers (278 pharmacists, nurses, social
  workers, students) asked 17 questions on smoking
  prevalence , treatment guidelines,
  pharmaco-therapy, drug interactions with
  nicotine, withdrawal signs symptoms.

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• Average score only 35.
• Only 6 of prescribers and 5 non-prescribers
  knew the Agency for Healthcare Research and
  Quality treatment guidelines for tobacco
  dependence.
• And only 1 of prescribers and 3 of
  non-prescribers could recognize the signs of
  nicotine withdrawal.
• When presented with a list of smoking-cessation
  drugs, 16 of prescribers and 8 of
  non-prescribers could differentiate between
  over-the-counter and prescription medications
  (P0.002).
• Despite lack of knowledge, 39 of prescribers and
  12 of non-prescribers (reported that they had
  been successful in getting patients to quit
  smoking (Plt0.0001).

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Pharmacists and Smoking Cessation

• Community pharmacists can provide behavioural
  support and advise on correct use of nicotine
  replacement therapy (NRT) products to aid smoking
  cessation.
• Self-reported cessation rates at 12 months 14.3
  versus 2.7 (p lt 0.001)
• Positive trend at follow-up with 12.0 versus
  7.4 (p 0.09) at nine months.
• Sinclair HK, Bond CM, Stead LF. Community
  pharmacy personnel interventions for smoking
  cessation. The Cochrane Database of Systematic
  Reviews 2008

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Confirmed abstinence rates at the end of 6 months
were 28 in the pharmacist- delivered
face-to-face treatment group and 11.8 in the
standard care telephone session control group (p
lt 0.041).The Annals of Pharmacotherapy 2009
February, Volume 43.
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Findings

• Post counseling awareness on smoking and
  cessation was observed to be significantly higher
  (plt 0.01).
• Among smokers counseled, 67 reported willingness
  to quit smoking.

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Smoking Cessation Counseling Practices of Texas
PharmacistsMeshack A et al. J Community Health,
Jan 2009.
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CSCSP

• Certified Smoking Cessation Service
• Provider
• Since 2004

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Aim of CSCSP Program

• To equip pharmacists with additional knowledge
  and skills in assisting smokers to quit.

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The CSCSP Team
NGO Malaysian Pharmaceutical Society Malaysian
Academy of Pharmacy Clearinghouse for Tobacco
Control
Government Sector Public Health Department of the
Ministry of Health
Private Pfizer Consumer Healthcare Johnson
Johnson
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Structure of CSCSP Program
Promotion (website, newsletter) Registration
Self study of CSCSP manual (2 - 4
weeks) Workshop (8 hours) Attachment at Quit
Smoking Clinic (8 hours)
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Content of CSCSP Manual

• Epidemiology and impact of tobacco use
• National tobacco control program
• Understanding tobacco dependence
• Management of tobacco dependence
• Behavioural intervention
• Pharmacological intervention
• Establishing and monitoring of service

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Workshop

• Lectures, video
• Role-play
• QA

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Smoking Cessation Counselling Flip-Chart
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Till April 2009

• No. of workshops 30 ( 6 per year)
• No. of certified pharmacists 730

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CSCSP Refresher Workshop

• To update knowledge and skills of certified
  pharmacists
• Half-day program, involves case discussion and
  interactive sessions

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Other activities of CSCSP1. Corporate Smoking
CessationProgram

• Interested companies invite pharmacists to give
  talks to their workers and assist them in quit
  smoking attempts.
• 3M Seremban (M) Sdn Bhd
• Intel Malaysia
• KEU Control Engineering Sdn Bhd
• Landmarks Bhd
• Malayan Banking Berhad
• MYDIN
• Royal Adelphi Hotel
• Shell Information Technology International S/B
• Sungei Wang Plaza Bhd 

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Other activities of CSCSP2. Quit-N-Win Challenge
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Other activities of CSCSP3. Newsletter -
CSCSPLINK
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Challenges

• Commitment
• Reimbursement issues
• Documentation
• Others

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Attitudes of Malaysian Pharmacists on Cessation
Service (n 136)
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Tobacco Industry
Weapon of mass destruction !
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SUMMARY

• Pharmacists can be in the frontline of
  prevention, detection and treatment of tobacco
  dependence.
• Need to include and/or increase public health
  component in the pharmacy curricula to produce
  pharmacists who are better prepared to provide
  tobacco cessation service.

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Acknowledgement

• MPS, Academy of Pharmacy
• MOH
• Dr. Sallehudin Abu Bakar, KL Health Department
• IIUM team
• Many others!

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THANK YOU