NRT Update and the NHS Tayside Community Pharmacy Stop Smoking Project

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NRT Update and the NHS Tayside Community
Pharmacy Stop Smoking Project

• Jacqueline Duncan
• Dundee CHP Pharmacy Public Health Development
  Officer

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NRT Update

• 29/12/05
• Letter from Prof Gordon Duff, Chairman of
  Commission on Human Medicines
• Expert Working Group on Committee for Safety of
  Medicines
• Risks vs benefits
• Expansion of recommended use of NRT in at risk
  populations
• Age 12 and above
• Pregnancy and breast feeding women
• CVD, hepatic and renal disease, diabetics, on
  other medication

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Age 12 to 18

• Still little information
• Limit use of NRT to 12 weeks

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Pregnancy and Breast Feeding

• Encouraged to continue to stop with
  non-pharmacological methods
• Still limited information re safety of NRT
• If do need NRT
• As early in pregnancy as possible
• Discontinue after 2-3 months
• Short acting better (e.g. microtabs rather than
  patches)
• Can use patches if absolutely necessary
• Remove at night
• Advice for breast feeding same
• Short acting better

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Medical History

• CVD (i.e. recent MI/CVA)
• Encouraged to stop with non-pharmacological
  methods
• Medical supervision
• Diabetes
• Monitor blood sugars
• Renal/hepatic impairment
• NRT with caution due to altered metabolism
• NRT/drug interactions
• Only significant interaction is with adenosine

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Reduce to Quit

• Safe to continue to smoke while using NRT
• Nicorette 2mg 4mg gum, Nicorette inhalator only
  licensed products
• Not supported by NHS Tayside

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The NHS Tayside Community Pharmacy Stop Smoking
Project
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Smoking Cessation

• Starting Fresh pilot of smoking cessation
  support by community pharmacists, and provision
  of NRT under PGD (Glasgow)
• Best Value Review
• Funding
• Similar service in Tayside
• BUT
• Initially limited to 600 patients in specific
  postcode areas (high deprivation)
• Still specified postcodes

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Patient Group Direction (PGD)

• The PGD for the issue of NRT to aid smoking
  cessation in subjects attending community
  pharmacies
• Allows ready accessibility to NRT
• Clients must be sufficiently motivated to quit
  smoking
• Can only be used within Tayside, by trained
  personnel
• Generic PGD

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PGD - Postcode Areas

• Angus
• DD10 8
• DD11 1
• DD11 5
• DD10 9
• DD8 1
• Perth and Kinross
• PH1 2
• PH1 5
• PH2 8
• Ph10 7

• Dundee
• DD1 1
• DD1 2
• DD1 3
• DD1 4
• DD1 5
• DD2 2
• DD2 3
• DD2 4
• DD3 0
• DD3 6
• DD3 7
• DD3 9
• DD4 0
• DD4 6
• DD4 8
• DD4 9

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Expectations

• From previous work
• Expect 6-9 uptake in smoking cessation
• 6000 9000 people across Tayside
• Expansion of existing services
• Adding another 60 or so venues
• Approx 2/3rds of all community pharmacies in
  Tayside

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Progress so far

• Less uptake than expected so far
• Considering expanding post code inclusion

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Future

• Pregnant women
• Mental Health
• On-line referral
• Prevention 2010

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Smoking Cessation who can do it?

• Trained pharmacists
• Trained dispensers
• Trained counter staff
• Trained nurses
• Trained lay people (coming)

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Over to you

• Any questions?
• jduncan_at_hawkhill.tayside.scot.nhs.uk