Skip to main content Accessibility help
×
Home

Treatment Outcome Assessment of the Pharmacist-Managed Quit Smoking Clinic in Malaysia

  • Asrul Akmal Shafie (a1), Mohamed Azmi Hassali (a1), Rudy Rabi (a2) and Mei Lin Lee (a3)

Abstract

Introduction: Evaluating a new health service is different from evaluating a new drug, as the former depends on the local delivery structure and culture. No data are available on the effectiveness of the existing pharmacist-managed quit smoking clinic (PM-QSC) in Malaysia. We evaluated the effectiveness in terms of the quit and default rate, the cost per quitter, cost per patient and the number of days of the patient remained in the managed care of the pharmacist.

Methods: The patients’ medical records at the PM-QSC in a tertiary hospital in Melaka, Malaysia, were examined retrospectively from January 2009 to December 2010. Patients were grouped into current smokers, attempted to quit and quitters. Costs were calculated per patient visit on the basis of resource used (smoking cessation agents (SCAs)) and the personnel involved (time spent by the pharmacist). This study was reviewed and approved by the Malaysia Research Ethics Committee (MREC).

Results: The quit rate between January 2009 and December 2010 was 5.8%, and the default rate was 71.8%. The average quit period for all smokers enrolled was 298 days. From the health provider perspective, the average costs per quitter, per patient and per quit attempt were MYR 953.28 (USD 308), MYR 55.71 (USD 18) and MYR 34.74 (USD 11), respectively.

Conclusion: The pharmacist delivery of cessation services at a public-funded QSC was associated with a high default rate. The pharmacist could not be dismissed entirely as an ineffective health care professional (HCP) for the provision of the cessation service based solely on this preliminary data, but these findings stress the need to address the high default rate prior to the expansion of the service.

Copyright

Corresponding author

Address for Correspondence: Dr Asrul Akmal Shafie, Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia. Email: aakmal@usm.my

References

Hide All
Abdullah, A., & Husten, C. (2004). Promotion of smoking cessation in developing countries: A framework for urgent public health intervention. Thorax, 59, 623630.
Akkaya, A., Oztürk, O., Cobanoğlu, H., Bircan, H. A., Simşek, S., & Şahin, Ü. (2006). Evaluation of patients followed up in a cigarette cessation clinic. Respirology, 11 (3), 311316. doi: 10.1111/j.1440-1843.2006.00843.x
Alberg, A. J., Stashefsky Margalit, R., Burke, A., Rasch, K. A., Stewart, N., Kline, J. A. et al. (2004). The influence of offering free transdermal nicotine patches on quit rates in a local health department's smoking cessation program. Addictive Behaviors, 29 (9), 17631778. doi: http://dx.doi.org/10.1016/j.addbeh.2004.04.007
An, L. C., Schillo, B. A., Kavanaugh, A. M., Lachter, R. B., Luxenberg, M. G., Wendling, A. H. et al. (2006). Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tobacco Control, 15 (4), 286293. doi: 10.1136/tc.2005.014555
Attebring, M., Herlitz, J., Berndt, A. K., Karlsson, T., & Hjalmarson, A. (2001). Are patients truthful about their smoking habits? A validation of self-report about smoking cessation with biochemical markers of smoking activity amongst patients with ischaemic heart disease. Journal of Internal Medicine, 249 (2), 145151. doi: 10.1046/j.1365-2796.2001.00770.x
Bauld, L., Chesterman, J., Ferguson, J., & Judge, K. (2009). A comparison of the effectiveness of group-based and pharmacy-led smoking cessation treatment in Glasgow. Addiction, 104 (2), 308316. doi: 10.1111/j.1360-0443.2008.02446.x
Boyd, K. A., & Briggs, A. H. (2009). Cost-effectiveness of pharmacy and group behavioural support smoking cessation services in Glasgow. Addiction, 104 (2), 317325. doi: 10.1111/j.1360-0443.2008.02449.x
Buck, D. J., Richmond, R. L., & Mendelsohn, C. P. (2000). Cost-effectiveness analysis of a family physician delivered smoking cessation program. Preventive Medicine, 31 (6), 641648. doi: http://dx.doi.org/10.1006/pmed.2000.0756
Cornuz, J., Gilbert, A., Pinget, C., McDonald, P., Slama, K., Salto, E. et al. (2006). Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: A multinational comparison. Tobacco Control, 15 (3), 152159. doi: 10.1136/tc.2005.011551
Crealey, G., McElnay, J., Maguire, T., & O’Neill, C. (1998). Costs and effects associated with a community pharmacy-based smoking-cessation programme. Pharmacoeconomics Economics, 14 (3), 323333. doi: 10.2165/00019053-199814030-00008
Cromwell, J., Bartosch, W. J., Fiore, M. C., Hasselblad, V., & Baker, T. (1997). Cost-effectiveness of the clinical practice recommendations in the ahcpr guideline for smoking cessation. Journal of the American Medical Association, 278 (21), 17591766.
Dent, L., Harris, K., & Noonan, C. (2007). Tobacco interventions delivered by pharmacists: A summary and systematic review. Pharmacotherapy, 27 (7), 10401051.
Dent, L., Scott, J., & Lewis, E. (2004). Pharmacist-managed tobacco cessation program in veterans health administration community-based outpatient clinic. Journal of the American Pharmacists Association, 44 (6), 700715.
Dent, L. A., Harris, K. J., & Noonan, C. W. (2009). Randomized trial assessing the effectiveness of a pharmacist-delivered program for smoking cessation. The Annals of Pharmacotherapy, 43 (2), 194201. doi: 10.1345/aph.1L556
Gilbert, A. R., Pinget, C., Bovet, P., Cornuz, J., Shamlaye, C., & Paccaud, F. (2004). The cost effectiveness of pharmacological smoking cessation therapies in developing countries: A case study in the Seychelles. Tobacco Control, 13 (2), 190195. doi: 10.1136/tc.2003.004630
Godfrey, C., Parrott, S., Coleman, T., & Pound, E. (2005). The cost-effectiveness of the English smoking treatment services: Evidence from practice. Addiction, 100 (Suppl. 2), 7083.
Hollis, J. F., McAfee, T. A., Fellows, J. L., Zbikowski, S. M., Stark, M., & Riedlinger, K. (2007). The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control, 16 (Suppl 1), i53i59. doi: 10.1136/tc.2006.019794
Hosking, W., Borland, R., Yong, H. H., Fong, G., Zanna, M., Laux, F. et al. (2009). The effects of smoking norms and attitudes on quitting intentions in Malaysia, Thailand and four Western nations: A cross-cultural comparison. Psychology and Health, 24 (1), 95107. doi: 10.1080/08870440802385854
Hughes, J. R., Keely, J. P., Niaura, R. S., Ossip-Klein, D. J., Richmond, R. L., & Swan, G. E. (2003). Measures of abstinence in clinical trials: issues and recommendations. Nicotine & Tobacco Research, 5 (1), 1325. doi: 10.1093/ntr/5.1.13
Joyce, G. F., Niaura, R., Maglione, M., Mongoven, J., Larson-Rotter, C., Coan, J. et al. (2008). The effectiveness of covering smoking cessation services for medicare beneficiaries. Health Services Research, 43 (6), 21062123. doi: 10.1111/j.1475-6773.2008.00891.x
Kennedy, D., Giles, J., Chang, Z., Small, R., & Edwards, J. (2002). Results of a smoking cessation clinic in community pharmacy practice. Journal of the American Pharmacists Association, 42 (1), 5156.
Kjaer, N. T., Evald, T., Rasmussen, M., Juhl, H. H., Mosbech, H., & Olsen, K. R. (2007). The effectiveness of nationally implemented smoking interventions in Denmark. Preventive Medicine, 45 (1), 1214. doi: http://dx.doi.org/10.1016/j.ypmed.2007.04.001
Kottke, T., Battista, R., DeFriese, G., & Brekke, M. (1998). Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. Journal of American Medical Association, 259 (19), 22822289.
Li, L., Borland, R., Yong, H. H., Fong, G. T., Bansal-Travers, M., Quah, A. C. et al. (2010). Predictors of smoking cessation among adult smokers in Malaysia and Thailand: Findings from the international tobacco control Southeast Asia survey. Nicotine & Tobacco Research, 12 (Suppl), S3444. doi: 10.1093/ntr/ntq030
Maguire, T. A., McElnay, J. C., & Drummond, A. (2001). A randomized controlled trial of a smoking cessation intervention based in community pharmacies. Addiction, 96 (2), 325331. doi: 10.1046/j.1360-0443.2001.96232516.x
Ministry of Health Malaysia. (2003). Treatment of tobacco use and dependence. Clinical Practice Guidelines. Retrieved 6th January 2010, from http://www.moh.gov.my/MohPortal/cpgDetail.jsp?action=view&id=11
Ministry of Health Malaysia. (2008). The third national health morbidity and mortality survey (NHMS III) 2006 (Vol. 2, pp. 152–167): Institute for Public Health.
Mudde, A. N., de Vries, H., & Strecher, V. J. (1996). Cost-effectiveness of smoking cessation modalities: Comparing apples with oranges? Preventive Medicine, 25 (6), 708716. doi: http://dx.doi.org/10.1006/pmed.1996.0110
Nielsen, K., & Fiore, M. C. (2000). Cost-benefit analysis of sustained-release bupropion, nicotine patch, or both for smoking cessation. Preventive Medicine, 30 (3), 209216. doi: http://dx.doi.org/10.1006/pmed.1999.0627
Öberg, M., Jaakkola, M. S., Woodward, A., Peruga, A., & Prüss-Ustün, A. (2011). Worldwide burden of disease from exposure to second-hand smoke: A retrospective analysis of data from 192 countries. The Lancet, 377 (9760), 139146.
Ong, M. K., & Glantz, S. A. (2005). Free nicotine replacement therapy programs vs implementing smoke-free workplaces: A cost-effectiveness comparison. American Journal of Public Health, 95 (6), 969975. doi: 10.2105/ajph.2004.040667
Parrott, S., Godfrey, C., Raw, M., West, R., & McNeill, A. (1998). Guidance for commissioners on the cost effectiveness of smoking cessation interventions. Health Educational Authority. Thorax, 53 (Suppl. 5) Pt 2, S138.
Philbrick, A. M., Newkirk, E. N., Farris, K. B., McDanel, D. L., & Horner, K. E. (2009). Effect of a pharmacist managed smoking cessation clinic on quit rates. Pharmacy Practice, 7 (3), 150156.
Ragucci, K. R., & Shrader, S. P. (2009). A method for educating patients and documenting smoking status in an electronic medical record. The Annals of Pharmacotherapy, 43 (10), 16161620. doi: 10.1345/aph.1M301
Ronckers, E. T., Groot, W., & Ament, A. J. H. A. (2005). Systematic review of economic evaluations of smoking cessation: Standardizing the cost-effectiveness. Medical Decision Making, 25 (4), 437448. doi: 10.1177/0272989x05278431
Roth, M. T., & Westman, E. C. (2001). Use of bupropion SR in a pharmacist-managed outpatient smoking-cessation program. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 21 (5), 636641. doi: 10.1592/phco.21.6.636.34548
Shearer, J., & Shanahan, M. (2006). Cost effectiveness analysis of smoking cessation interventions. Australian and New Zealand Journal of Public Health, 30 (5), 428434. doi: 10.1111/j.1467-842X.2006.tb00458.x
Siahpush, M., McNeill, A., Borland, R., & Fong, G. T. (2006). Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: Findings from the international tobacco control (ITC) four country survey. Tobacco Control, 15 (Suppl. 3), iii71iii75. doi: 10.1136/tc.2004.008763
Sippel, J. M., Osborne, M. L., Bjornson, W., Goldberg, B., & Buist, A. S. (1999). Smoking cessation in primary care clinics. Journal of General Internal Medicine, 14 (11), 670676.
Song, F., Raftery, J., Aveyard, P., Hyde, C., Barton, P., & Woolacott, N. (2002). Cost-effectiveness of pharmacological interventions for smoking cessation: A literature review and a decision analytic analysis. Medical Decision Making, 22 (Suppl. 1), s26s37.
SRNT Subcommittee on Biochemical Verification. (2002). Biochemical verification of tobacco use and cessation. Nicotine & Tobacco Research, 4 (2), 149159. doi: 10.1080/14622200210123581
Thavorn, K., & Chaiyakunapruk, N. (2008). A cost-effectiveness analysis of a community pharmacist-based smoking cessation programme in Thailand. Tobacco Control, 17 (3), 177182. doi: 10.1136/tc.2007.022368
Wee, L. H., Shahab, L., Bulgiba, A., & West, R. (2011). Stop smoking clinics in Malaysia: Characteristics of attendees and predictors of success. Addictive Behaviors, 36 (4), 400403. doi: http://dx.doi.org/10.1016/j.addbeh.2010.11.011
Wee, L. H., West, R., Bulgiba, A., & Shahab, L. (2011). Predictors of 3-month abstinence in smokers attending stop-smoking clinics in Malaysia. Nicotine & Tobacco Research, 13 (2), 151156.
West, R., Hajek, P., Stead, L., & Stapleton, J. (2005). Outcome criteria in smoking cessation trials: Proposal for a common standard. Addiction, 100 (3), 299303. doi: 10.1111/j.1360-0443.2004.00995.x
Zillich, A. J., Ryan, M., Adams, A., Yeager, B., & Farris, K. (2002). Effectiveness of a pharmacist-based smoking-cessation program and its impact on quality of life. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 22 (6), 759765. doi: 10.1592/phco.22.9.759.34073

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed