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NRT Update and the NHS Tayside Community Pharmacy Stop Smoking Project

NRT Update and the NHS Tayside Community Pharmacy Stop Smoking Project. Jacqueline Duncan Dundee CHP Pharmacy Public Health Development Officer. NRT Update. 29/12/05 Letter from Prof Gordon Duff, Chairman of Commission on Human Medicines

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NRT Update and the NHS Tayside Community Pharmacy Stop Smoking Project

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  1. NRT Update and the NHS Tayside Community Pharmacy Stop Smoking Project Jacqueline Duncan Dundee CHP Pharmacy Public Health Development Officer

  2. NRT Update • 29/12/05 • Letter from Prof Gordon Duff, Chairman of Commission on Human Medicines • Expert Working Group on Committee for Safety of Medicines • Risks v’s benefits • Expansion of recommended use of NRT in at risk populations • Age 12 and above • Pregnancy and breast feeding women • CVD, hepatic and renal disease, diabetics, on other medication

  3. Age 12 to 18 • Still little information • Limit use of NRT to 12 weeks

  4. Pregnancy and Breast Feeding • Encouraged to continue to stop with non-pharmacological methods • Still limited information re safety of NRT • If do need NRT • As early in pregnancy as possible • Discontinue after 2-3 months • Short acting better (e.g. microtabs rather than patches) • Can use patches if absolutely necessary • Remove at night • Advice for breast feeding same • Short acting better

  5. Medical History • CVD (i.e. recent MI/CVA) • Encouraged to stop with non-pharmacological methods • Medical supervision • Diabetes • Monitor blood sugars • Renal/hepatic impairment • NRT with caution due to altered metabolism • NRT/drug interactions • Only significant interaction is with adenosine

  6. Reduce to Quit • Safe to continue to smoke while using NRT • Nicorette 2mg & 4mg gum, Nicorette inhalator only licensed products • Not supported by NHS Tayside

  7. The NHS Tayside Community Pharmacy Stop Smoking Project

  8. Smoking Cessation • Starting Fresh – pilot of smoking cessation support by community pharmacists, and provision of NRT under PGD (Glasgow) • Best Value Review • Funding • Similar service in Tayside BUT • Initially limited to 600 patients in specific postcode areas (high deprivation) • Still specified postcodes

  9. Patient Group Direction (PGD) • The PGD for the issue of NRT to aid smoking cessation in subjects attending community pharmacies • Allows ready accessibility to NRT • Clients must be sufficiently motivated to quit smoking • Can only be used within Tayside, by trained personnel • Generic PGD

  10. Angus DD10 8 DD11 1 DD11 5 DD10 9 DD8 1 Perth and Kinross PH1 2 PH1 5 PH2 8 Ph10 7 Dundee DD1 1 DD1 2 DD1 3 DD1 4 DD1 5 DD2 2 DD2 3 DD2 4 DD3 0 DD3 6 DD3 7 DD3 9 DD4 0 DD4 6 DD4 8 DD4 9 PGD - Postcode Areas

  11. Expectations • From previous work • Expect 6-9% uptake in smoking cessation • ~6000 – 9000 people across Tayside • Expansion of existing services • Adding another 60 or so venues • Approx 2/3rds of all community pharmacies in Tayside

  12. Progress so far • Less uptake than expected so far • Considering expanding post code inclusion

  13. Future • Pregnant women • Mental Health • On-line referral • Prevention 2010

  14. Smoking Cessation –who can do it? • Trained pharmacists • Trained dispensers • Trained counter staff • Trained nurses • Trained lay people (coming)

  15. Over to you • Any questions? jduncan@hawkhill.tayside.scot.nhs.uk

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