Fiorina Caravona Di Losa, pharmacist manager at West Howe Pharmacy in Bournemouth, talks to Saša Janković about running a smoking cessation service.

Service type: Smoking cessation.

Name of pharmacy: Avicenna West Howe Pharmacy, Bournemouth.

Name of pharmacist manager: Fiorina Caravona Di Losa.

Why did you start offering this service?

We started offering this service in December 2016.

Smoking is the number one cause of preventable death globally, causing more than 450,000 deaths every year, so I started offering this service as stopping smoking can give lots of benefits. Smoking seriously harms your health, but once you stop your body starts to repair itself. The benefits of stopping smoking begin in as little as one hour after the last cigarette, plus the sooner a smoker quits, the faster they will reduce their risk of lung disease, heart disease and cancer.

Within days of stop smoking, quitters experience a drop in heart rate; carbon monoxide and oxygen levels in their blood return to normal (similar to those who've never smoked); their risk of heart attack begins to decrease and their blood pressure begins to drop, decreasing the risk of heart disease from smoking induced high blood pressure; and they will have a heightened sense of smell and more vivid taste. Within weeks they will benefit from improved lung function, less coughing and shortness of breath, and their circulation continues to improve. One year after quitting smoking, a person's risk for coronary heart disease decreases by half, and this risk continue to drop past the one-year mark.

How much did it cost to set up the service?

There was no cost.

What, if any, training did you or other team members have to undergo?

I completed online and face-to-face training for a stop smoking qualification with the National Centre for Smoking Cessation and Training (NCSCT).

In a nutshell, what does the service involve? 

Quitting smoking means breaking the cycle of addiction and, essentially, rewiring the brain from craving nicotine, but to be successful, smokers who want to quit need to have a plan in place to beat their cravings.

The stop smoking service involves several different treatments to help them beat their addiction and reduce withdrawal symptoms depending on their age, if they are pregnant or breastfeeding, and any medical conditions they have.

We offer patients nicotine replacement therapy (NRT) in various forms – gum, transdermal patch, nasal spray, oral inhaler, and tablet – all of which we find are most effective when the quitter also receives parallel cessation-counselling, although they are effective even without accessing behavioural therapy. Often the best way to use NRT is to combine a patch with a faster acting form such as gum, inhalator or nasal spray, and treatment with NRT usually lasts 8-12 weeks before the patient gradually reduces the dose and eventually stops.

I will also advise patients about varenicline (Champix), as evidence suggests it's the most effective medicine for helping people to stop smoking. The treatment is a 12-week course of tablets which can help to relieve the craving and withdrawal symptoms associated with stopping smoking. During the first two weeks of taking Champix, the person will continue to smoke, with most people setting their quit date between 10 to 14 days later. After that they are not recommended to smoke, but if they do the Champix can reduce the enjoyment they feel from smoking cigarettes, which is an added incentive for them to quit.

How have patients responded to the service?

At least 95% of our patients have reported positive effects from smoking cessation. Most of them tell us that their stress, depression and anxiety have significantly decreased after a few weeks of stopping smoking. Blood oxygen levels go up for most of them after a few months of quitting, and their sense of taste and smell improves. In addition, a lot of people who have got asthma are no longer using their inhaler after going through the stop smoking service.

Roughly how often each month do you carry out the service?

I see people for smoking cessation about seven or eight times a week.

How much do you charge for the service?

If the patient is not exempt then there is the NHS charge for every item that they have.

Roughly how much a month do you make from offering the service?

We make £2,000/2,500 a month - more or less - from smoking cessation.

Would you recommend offering this service to other contractors? 

Yes of course. Kicking the tobacco habit offers a lot of benefit to patients – it lowers their risk of cancer and diabetes and helps their lungs and heart – so I think every pharmacy should be able to offer a smoking cessation service.

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