1. Hilary Millar, Val Reilly, Liz McGovern
2. NHS Smoking Cessation Services (Scotland) 1 April to 31 March Publication date 4th October Information Services Division
2. NHS Smoking Cessation Services (Scotland) 1 April to 31 March Publication date 4th October Information Services Division
Building community pharmacist varenicline prescribing confidence to improve smoking cessation outcomes.
Hilary Millar, Val Reilly, Liz McGovern
Pharmacy Public Health, NHS Greater Glasgow and Clyde (NHSGGC), West House, Gartnavel Royal Campus, Glasgow
Introduction
Community pharmacy supports the majority of smoking cessation quit attempts in Scotland 1.
Varenicline delivers higher quit rates than other pharmacotherapy2.
Since May 2016 varenicline has been a first line therapy option for smoking cessation in community pharmacy in NHSGGC.
Prescribing of varenicline in NHSGGC in 2015/16 was only 7% compared with 11% in Scotland and 25% in England1
Results
135 pharmacists and pre-registration pharmacists attended training.
Evaluation from 113 participants was extremely positive with 96 (85%) reporting increased confidence to prescribe varenicline.
The most highly valued section of the training was the opportunity to discuss varenicline prescribing with community pharmacist peers.
Varenicline prescribing in NHSGGC increased from 8% in June 2016 to 23% in June See Figure1.
Smoking quit rates at 4 weeks from January 2017 to May 2018 averaged 46% for varenicline compared to the 32% success rate shown with NRT
At 12 weeks post quit the quit rate with varenicline was 29% compared to 17% with NRT see Figure 2.
Aim
To reduce the barriers to the use of varenicline in community pharmacy smoking quit attempts.
To compare smoking cessation outcomes between clients using varenicline and those using Nicotine Replacement therapy (NRT) in a single health board.
Method
The NHSGGC Pharmacy Public Health Improvement team developed a 2.5 hour training for community pharmacists’ regarding prescribing varenicline under Patient Group Direction (PGD) .
Training included:
Pharmacology and efficacy of varenicline
The newly reviewed NHSGGC Varenicline PGD, highlighting key changes e.g option as first line therapy, removal of key contraindications.
EAGLES study2 results highlighting safety and efficacy particularly in individuals with mental health problems
A peer panel session led by experienced community pharmacists regularly prescribing varenicline .
Training was delivered on five occasions (three evening and two half day sessions) between June 2016 and October 2017.
Post course evaluation questionnaire included confidence to prescribe varenicline
Percentage of quit attempts in pharmacies using varenicline were recorded from January 2016 to June 2018.
Smoking cessation outcomes using varenicline and NRT were compared at 4 and 12 weeks post quit from January 2017 to May 2018.
Conclusion
Face to face training which included peer assisted learning was well received by community pharmacists, who believed that it improved their confidence to prescribe varenicline.
The extent of varenicline prescribing by NHSGGC community pharmacists increased.
Varenicline was almost twice as successful as NRT for quitting smoking at 12 weeks (28% versus 17%) 
References
NHS Smoking Cessation Services (Scotland) 1 April to 31 March 2016 publication date 4 October 2016 Information Services Division .
Neuropsychiatric safety and efficacy of varenicline, bupropion and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind randomised, placebo-controlled clinical trial.