Smoking Cessation: Getting Patients on Board

Nearly 70% of smokers want to quit smoking, according to the CDC.¹ Pharmacists are ideally situated to help these individuals, and this article highlights tools and resources they can use. Recent information on prescription-only smoking cessation medications is also provided.

Many pharmacists have told me of their difficulty in getting patients to attend smoking cessation programs. However, Travis Wolff, PharmD, owner of Med World Pharmacy in Sapulpa, Oklahoma, successfully implemented a smoking cessation program at his pharmacy. In a recent conversation with Wolff, he expressed his strong belief in the positive impact of motivational interviewing, recommending that pharmacists start by telling patients about 1 positive result that will come from stopping smoking and follow it up by asking, “Will that be helpful for you?” Wolff emphasizes the importance of personalizing the positive outcome to the patient’s life or situation. He also suggests using conversations with patients as a starting point and continuing with, “Let’s talk about that. Tell me more.” Then you can delve into why stopping smoking may help them.

If you offer a smoking cessation program, tell patients they have been chosen for the free program to help them stop smoking. Wolff has found success with calling his patients personally.

WHAT IS MOTIVATIONAL INTERVIEWING?

Motivational interviewing is a patient-centered communications skillset used to address negative health behaviors. Even when applied to short conversations, this technique has proved to positively impact patient outcomes via health behavior changes. To remember the key components of motivational interviewing, pharmacists should remember RULE2 (TABLE 1):

• Resist the righting reflex

• Understand your patient’s motivations

• Listen

• Empower your patient

They should also follow the OARS mnemonic device:

• Open-ended questions

• Affirmations

• Reflective listening

• Summaries² (ONLINE TABLE 2)

The spirit of motivational interviewing is one of collaboration between health care providers and patients. When viewed through the eyes of a partnership, motivational interviewing is done with patients, not to them. Like a choreographed dance, health care providers should move with patients to set in motion their internal motivation to make positive changes.²

VARENICLINE (CHANTIX) AND BUPROPION (ZYBAN)

After reviewing data from a large clinical trial led by the manufacturers of varenicline (Chantix) and bupropion (Zyban), the FDA concluded that the risk for mental health adverse effects (AEs) from these products may be lower than previously thought and removed the associated boxed warnings from the prescribing information for both products,³ adding that most individuals who experience these AEs do not have to be hospitalized or suffer serious consequences. The clinical trial results confirmed that the benefits of varenicline and bupropion outweigh their risks. However, the agency also noted that the risk for mental health AEs (eg, changes in mood, behavior, or thinking) still exists, especially in individuals who have been or are being treated for mental illnesses such as anxiety disorders, schizophrenia, or depression.

Going forward, the warning section for both medications will include the results of the recent trial.³ According to the FDA, patients who experience mental health AEs should stop taking these medications and notify their health care provider.³

PATIENT RESOURCES

The CDC provides QuitGuide, a free smoking cessation app, for Apple and Android devices (cdc.gov/tobacco/campaign/tips/quit-smoking/mobile-quit-guide/index.html), that offers patients an easy way to track their cravings, smoking triggers, moods, and slipups. Through messaging, the app can help patients stay motivated by offering tips and distractions for dealing with cravings.⁴

The National Cancer Institute quitline is 1-877-44U-QUIT (1-877-448-7848) and the states’ quitline is 1-800-QUIT-NOW (1-800-784-8669).⁵ Another resource is SmokefreeTXT, a mobile text messaging platform that provides 24/7 advice, encouragement, and tips to help patients quit smoking. This service can be found at https://smokefree.gov/tools-tips/smokefreetxt-signup.⁵

References

• Quitting smoking. CDC website. cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/. Accessed January 21, 2017.
• Salvo MC, Cannon-Breland ML. Motivational interviewing for medication adherence. J Am Pharm Assoc. 2015;55(4):e354-e61; quiz e362-3. doi: 10.1331/JAPhA.2015.15532.
• FDA Drug Safety Communication: FDA revises description of mental health side effects of the stop-smoking medicines Chantix (varenicline) and Zyban (bupropion) to reflect clinical trial findings. FDA website. www.fda.gov/Drugs/DrugSafety/ucm532221.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery. Published March 9, 2015. Updated December 16, 2016. Accessed January 15, 2017.
• FREE QuitGuide Mobile App. CDC website. cdc.gov/tobacco/campaign/tips/quit-smoking/mobile-quit-guide/index.html. Accessed January 15, 2017.
• Quitting resources. CDC website. cdc.gov/tobacco/campaign/tips/quit-smoking/quitting-resources.html. Accessed January 15, 2017.