Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy

With the emerging and promising role of healthcare professionals in implementing smoking cessation services, community pharmacists, in particular, can play a pivotal role. The aim of this meta-analysis is to evaluate the effectiveness of smoking cessation interventions delivered by community pharmacists in assisting smokers to quit.

PubMed, EMBASE, Scopus, International Pharmaceutical Abstracts and ISI Web of Knowledge were searched from inception to May 2013. Original research articles were selected for review, if they addressed the effectiveness of pharmacy-based interventions in smokers vs. a control group and reported smoking abstinence rates as an outcome. Obtained studies were assessed for methodological quality using the Cochrane Effective Practice and Organization of Care Group risk of bias tool. The primary outcome of measure was smoking abstinence based on the 'most rigorous criterion'. Pooled relative risks (RR) with 95% confidence interval (CI) were estimated using the Dersimonian and Laird random-effects models. Corresponding subgroup met-analysis was performed.

Of the 1168 articles extracted, five studies (three randomized controlled trials and two controlled before-after studies) met the inclusion criteria, involving a total of 1426 smokers. Pharmacist interventions showed better abstinence rates as compared with controls (RR 2·21, 95% CI 1·49-3·29). Compared with the control group, the RR (95% CI) in the intervention group was 3·21 (1·81-5·72) for clinically validated abstinence and 1·66 (1·08-2·54) for self-reported abstinence. In the intervention group, the RR for short-term and long-term abstinence was 2·48 (1·15-5·31) and 2·40 (1·37-4·23), respectively.

Pharmacist-led interventions can significantly impact abstinence rates in smokers. Health policymakers should direct incentives for community pharmacists to provide such services.