A community-based pharmacist-led smoking cessation program, before elective total joint replacement surgery, markedly enhances smoking cessation rates
More details
Hide details
Department of Physical Therapy, University of Alberta, Edmonton, Canada
Department of Surgery, University of Alberta, Edmonton, Canada
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
Lauren A. Beaupre   

Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall Edmonton, AB, Canada T6G 2G3
Publication date: 2020-09-14
Tob. Induc. Dis. 2020;18(September):78
We compared smoking cessation outcomes between those who used a pharmacist-led community-based smoking cessation intervention and those who did not, prior to total joint replacement (TJR) surgery. Also, we examined intervention characteristics (e.g. number/duration of sessions attended, recommended therapy) and smoking cessation outcomes.

This prospective evaluation was nested within a comparative study from a centralized clinic that prepares over 3000 patients annually for TJR and focused on participants referred to the community-based smoking cessation program preoperatively. Pharmacists offered an individualized evidence-based intervention and collected visit, duration and intervention data. Smoking cessation, the primary outcome, was ascertained independently of participating pharmacists at 6 weeks post-operative using exhaled CO monitoring and at 6 months post-recruitment via telephone interview.

Of 286 eligible candidates, 104 agreed to participate, with one subsequently withdrawing (n=103). At 6 weeks post-operatively, 66/103 (64%) participants returned for study re-assessment while 63/103 (61%) participants completed the post-recruitment interview at 6 months; non-respondents to study follow-up were considered smokers. Of 103 participants, 58 (56%) consulted with a pharmacist; those who did not consult a pharmacist (n=45) were slightly younger (p=0.02) with significantly higher CO level (p=0.02) on study entry. Validated 7-day point prevalence abstinence (PPA) at 6 weeks post-operative was 11/58 (19%) in pharmacist-compliant participants compared to 2/45 (4%) in non-compliant participants (p=0.04). At 6 months post-recruitment, 19/58 (33%) pharmacistcompliant participants self-reported a 7-day PPA compared to 2/45 (4%) by non-compliant participants (p<0.001). For pharmacist-compliant participants, 33/58 (54%) saw the pharmacist 4 times; the mean overall pharmacist time was 71.8±24.4 minutes/patient with 26/58 (45%) and 19/58 (33%) prescribed nicotine replacement therapy and varenicline, respectively, and 13/58 (22%) not using medication; post hoc analysis suggested varenicline was marginally more effective for smoking cessation than no medication (p=0.04).

Community-based pharmacist-led smoking cessation programs are an effective addition to usual preoperative care for smokers awaiting elective TJR. Using existing community resources led to higher smoking cessation rates in smokers waiting for TJR relative to those not using these resources.

The authors acknowledge the support of the clinical staff of the Edmonton Bone and Joint Clinic who assisted with data collection and supported the study taking place in the clinic as well as Safeway Canada, who partnered with us to implement the program.
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. All the authors report grants from Pfizer, during the conduct of the study.
This study was supported by a Global Research Award in Nicotine Dependence (GRAND) sponsored by Pfizer. The funders played no role in the study design, data collection or analysis or content of the manuscript. The funders take no responsibility for the conduct, results or opinions expressed in this manuscript.
Study concept and design: LAB, BF, FH, EM and RS; Acquisition of the data: LAB and FH; Analysis and interpretation of data: LAB, BF, FH, EM and RS; Drafting of the manuscript: LAB, BF and FH; Critical revision of the manuscript for important intellectual content: LAB, BF, FH, EM and RS.
Not commissioned; externally peer reviewed.
Thomsen T, Villebro N, Moller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;2014(3):CD002294. doi:10.1002/14651858.cd002294.pub4.
An D , Wong J. Improving Surgical Outcomes and Patient Health: Perioperative Smoking Cessation Interventions. Curr Anesthesiol Rep. 2020;10:12-18. doi:10.1007/s40140-020-00370-0.
Government of Canada. Canadian Tobacco and Nicotine Survey (CTNS): summary of results for 2019. Accessed September 10, 2020.
Sachs R, Wild TC, Thomas L, Hammal F, Finegan BA. Smoking cessation interventions in the pre-admission clinic: assessing two approaches. Can J Anaesth. 2012;59(7):662-669. doi:10.1007/s12630-012-9716-6.
Carson-Chahhoud KV, Livingstone-Banks J, Sharrad KJ, et al. Community pharmacy personnel interventions for smoking cessation. Cochrane Database Syst Rev. 2019. doi:10.1002/14651858.CD003698.pub3.
Saba M, Diep J, Saini B, Dhippayom T. Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. J Clin Pharm Ther. 2014;39(3):240-247. doi:10.1111/jcpt.12131.
Beaupre LA, Hammal F, DeSutter C, Stiegelmar RE, Masson E, Finegan BA. Impact of a standardized referral to a community pharmacist-led smoking cessation program before elective joint replacement surgery. Tob Induc Dis. 2019;17(February). doi:10.18332/tid/101600.
SRNT Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002;4(2):149-159. doi:10.1080/14622200210123581.
Canadian Pharmacists Association. QUIT: Quit Using and Inhaling Tobacco. Accessed September 10, 2020.
Canadian Pharmacists Association. Pharmacists' Expanded Scope of Practice in Canada. Published 2015. Accessed January 5, 2016.
Jimenez-Ruiz CA, Andreas S, Lewis KE, et al. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J. 2015;46:61-79. doi:10.1183/09031936.00092614.
Shi Y, Warner DO. Surgery as a teachable moment for smoking cessation. Anesthesiology. 2010;112:102-107. doi:10.1097/aln.0b013e3181c61cf9.