This study is a first attempt to describe the role of community pharmacists in smoking cessation in Poland. We surveyed three different groups: current adult smokers, community pharmacists, and pharmacy students to provide a broad perspective. The survey results indicate that the majority of current smokers did not anticipate seeking general counseling from a health provider to quit smoking. These results confirm existing research that smokers in general avoid counseling (Foulds, Steinberg, Williams, & Ziedonis, 2006
). Surveyed smokers who might consider seeking assistance with future quit attempts ranked pharmacists first for those they would consult for pharmacological support for quitting, and second to addiction specialists as the category of health professionals from whom they would ask for supportive counseling.
We found that a high percentage of community pharmacists believed they were ready to provide cessation support to their smoking clients. These findings are similar to those from surveys of community pharmacists in Thailand and the United States (Hudmond, Prokhorov, & Corelli, 2006
; Thananithisak, Nimpitakpong, & Chaiyakunapruk, 2008
; Williams, Newsom, & Brock, 2000
). Results published by Williams et al. (2000)
also suggested that pharmacists do not routinely identify smokers and perceive several barriers to participating in smoking cessation activities. Although our study in Poland did not assess these factors, it is possible that there are existing and unaddressed barriers to community pharmacists providing smoking cessation services for their clients.
The survey results from pharmacy students indicate that tobacco-related topics discussed as part of the undergraduate curriculum have a greater emphasis on the “science” of tobacco and tobacco smoking (e.g., their toxicology) than on the “practical” aspects of treating tobacco dependence (e.g., nicotine pharmacology). These results are consistent with the results of our previous study suggesting that pharmacy education for Polish students lacks information about the pharmacological aspects of nicotine dependence (Goniewicz, Czogala, & Koszowski, 2005
). Recently published data from surveys performed in universities in Germany and United Kingdom showed that medical students also lacked relevant information about smoking and health and the effectiveness of cessation methods (Raupach et al., 2009
As previously noted, Article 14 of the FCTC indicates that to address the global tobacco epidemic, countries should increase cessation services for smokers. Community pharmacists can be a part of a country’s response to this charge. In Poland, we found that current smokers are interested in quitting, as evidenced by their previous quit attempts and their intention to quit in the future, and there is receptivity to turning toward community pharmacists for pharmacological assistance with quitting. We also found that practicing community pharmacists as well as pharmacy students are willing and interested in providing smoking cessation services to clients. To enhance the capacity of pharmacists in practice to provide smoking cessation services, the curriculum for pharmacy students may be changed to provide more practical training on counseling and advising patients on smoking cessation. Continuing education seminars for practicing pharmacists can also emphasize best practices in the counseling and advising of community pharmacy clients who are seeking help with smoking cessation.
Pharmacists in Poland could follow the lead of other EU members and expand their smoking cessation services to include information about the safety and efficacy of NRT, as well as supportive counseling to encourage pharmacy clients to quit smoking (Bansal, Cumming, Hyland, & Giovino, 2004
). At present, there are no specific guidelines for community pharmacists in Poland on how to counsel nicotine-dependent patients. A good place to start might be the implementation of the 5A’s strategy (Ask, Advise, Assess, Assist, Arrange), which is recommended in the United States by the Department of Health and Human Services and which has been shown to be effective in various clinical settings and primary care (Bentz et al., 2007
; Cromwell, Bartosch, Fiore, Hasselblad, & Baker, 1997
; Fiore et al., 2008
; Gordon, Andrews, Crews, Payne, & Severson, 2007
). The 5A’s strategy is designed to be brief (3 min or less) and has five steps: (a) A
sk the patient whether he or she uses tobacco, (b) A
dvise him or her to quit, (c) A
ssess willingness to make a quit attempt, (d) A
ssist him or her in making a quit attempt, and (e) A
rrange for follow-up contacts to prevent relapse. Continuing education units could include practical exercises, implementation of pharmaceutical practice guidelines, and providing quick reference guides and be sponsored and supported by health professional associations (e.g., societies of pharmacists; Wick, Ackermann-Liebrich, Bugnon, & Ceriese, 2000
As for pharmacy students, comprehensive tobacco cessation training could be a core component of pharmacy school curricula. A recent survey of faculty in 82 U.S. pharmacy schools ranked the topics of “aids for cessation,” “assisting patients with quitting,” and “drug interactions with smoking” as the most important areas to prepare students with training in smoking cessation (Hudmon, Bardel, Kroon, Fenlon, & Corelli, 2005
). Research has shown that the addition of a smoking cessation curriculum results in an improvement in pharmacy students’ perceived confidence and ability to provide tobacco smoking cessation (Corelli et al., 2005
This study has several limitations. The surveys were developed for quick assessment of the three groups. Because there is a lack of similar tools, no construct validity was performed. Although the study was done in Poland, the surveys might easily be implemented in other European countries, particularly those with similar health systems. Another limitation of our study is the lack of objective data about the actual level of knowledge about tobacco addiction and dependence treatment among Polish community pharmacists and pharmacy students. Based on our data it is also difficult to assess whether community pharmacists think that smoking cessation is important for their patients. These issues should be studied in detail in the future.
In addition to enhancing the capacity of community pharmacists to address smoking cessation, increasing their role in smoking cessation will depend on alerting the general public to the availability of smoking cessation services at the local pharmacy. As a first step, community pharmacies could create prominent displays of smoking cessation information and available products, indicating that the pharmacists are able to provide further support for those ready to quit. Perhaps practicing community pharmacists who have received continuing education in smoking cessation could indicate this advanced training through a sign or designation within the pharmacy. Poland’s national quit line could also refer callers to the pharmacists with this additional training. Through modest changes in pharmacy school curriculum, tobacco cessation–specific continuing education for community pharmacists, and increasing awareness among smokers in the general public that community pharmacists are an accessible resource to aid in quitting, Poland can expand access to competent cessation and counseling services. Other countries may use the same strategies or adapt them as necessary.