Impact of a standardized referral to a community pharmacist-led smoking cessation program before elective joint replacement surgery
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Collaborative Orthopaedic Research (CORe), Department of Physical Therapy, University of Alberta, Edmonton, Canada
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
Collaborative Orthopaedic Research (CORe), Department of Surgery, University of Alberta, Edmonton, Canada
Lauren A. Beaupre   

Collaborative Orthopaedic Research (CORe), Department of Physical Therapy, 6-110 Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
Publish date: 2019-02-22
Tob. Induc. Dis. 2019;17(February):14
Smokers undergoing total joint replacement (TJR) are more likely to develop infections and be re-admitted than non-smokers. The primary purpose of this study was to evaluate the effectiveness of standardized preoperative referral to a community-based pharmacist-led smoking cessation program compared to usual care for patients undergoing TJR. Secondarily, we evaluated the use of the smoking cessation program.

A pre-post quasi-experimental study was conducted at a central intake clinic that prepares approximately 3000 TJR patients annually. Participants were recruited at a mean of 13±11.1 weeks preoperatively and provided informed consent. Participants in the ‘pre’ observational phase (OP) received usual care for smoking cessation. For ‘post’ intervention phase (IP) participants, a referral was sent to a community-based pharmacist-led smoking cessation program. Smoking status was validated on study entry using exhaled carbon monoxide. Participants’ smoking status was re-assessed using self-reported point prevalence abstinence at 6 months post-recruitment.

We enrolled 120/150 (80%) potential OP candidates and 104/286 (36%) potential IP candidates. The groups were similar on study entry; overall, the mean age of participants was 58.7±9.1 years and 103 (47%) were male. They reported medium nicotine dependence with 37±11.6 mean years smoked. At 6 months post-recruitment, 8 (7%) OP participants self-reported 30-day point prevalence abstinence compared to 21 (20%) IP participants (p=0.003). Only 58 (56%) IP participants complied with the pharmacist referral, with 19 (33%) of those seeing the pharmacist reporting point prevalence abstinence at 6 months compared to only 2 (4%) of the 45 participants who did not see the pharmacist (p<0.001).

Referral to a community smoking cessation program as preoperative standard of care is feasible and can enhance long-term quit rates, but voluntary participation led to low recruitment to the program.

The authors declare that they have no competing interests, financial or otherwise, related to the current work. BA Finegan reports grants from Pfizer, during the conduct of the study and personal fees from Pfizer, outside the submitted work. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
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