Tobacco use is the leading preventable cause of death and disease in the United States,1 but how best to help patients quit? US Public Health Service guidelines recommend a 2-tiered approach consisting of counseling and pharmaceutical treatment.2 Because primary care physicians are busy caring for other patients, however, and pharmacists in our state can prescribe medication under collaborative practice agreements with physicians, we piloted a single-visit smoking cessation group intervention conducted by a pharmacist (NP) and health coach (HW).
Patients were recruited from 2 primary care practices to participate in a 2-hour group visit that included both behavioral and pharmacologic interventions. Follow-up phone calls and in-person visits with the health coach were made available, but were not part of the structured curriculum.
We used motivational interviewing to assist patients in developing individualized quit plans and offered small rewards for stopping, such as a note pad and 6-month certificate. Patients did not pay for the group visit, but were required to pay for pharmacotherapy (health insurance or out of pocket).
Between September 2011 and May 2012, a total of 35 patients attended one of 7 smoking cessation group visits. Twenty-seven (77%) participants opted for medication or nicotine replacement therapy and 23 (65.7%) used the health coach services.
As of June 2012—with participants ranging from one month to 9 months’ follow-up—23% remained tobacco free. This compares with documented one-year quit rates of 3% to 5% (unassisted), 7% to 16% (with behavioral intervention), and up to 24% with pharmacologic treatment and ongoing behavioral support.3 Similar smoking cessation rates have been described with multiple-session pharmacist-led group visits.4 This pilot program demonstrated that a single group intervention can be performed in a primary care setting with a pharmacist and health coach, freeing physicians to care for other patients.
Challenges include variable reimbursement from insurers for pharmacist-led tobacco cessation group visits and disparate pharmacy policies—pharmacists are not allowed to prescribe medication in every state. Nonetheless, this pilot, funded by Fairview Physician Associates and the University of Minnesota Academic Health Center, represents a promising means of delivering effective preventive services by leveraging team members in a busy primary care clinic.
Nicole Paterson, PharmD, BCPS
Holly Wiest, MA
Lynne Fiscus, MD, MPH
Minneapolis, Minn