title: Cluster-Randomized Trial of Clinical Pharmacist Tobacco Cessation Counseling Among Patients with Cardiovascular Disease.
abstract: Optimal management of patients with cardiovascular disease (CVD) includes evaluation of risk factors using a team-based approach. Tobacco use often receives less attention than other CVD risk factors; therefore, utilization of nonphysician health care providers may be valuable in addressing tobacco use. The purpose of this trial was to assess the impact of brief, structured, telephone tobacco cessation counseling (BST) delivered by clinical pharmacists on tobacco cessation attempts compared to usual care. The BST consisted of 1 to 5 minutes discussing 3 key counseling points, including a recommendation to quit and education about cessation aids. This was a cluster-randomized trial of tobacco-using patients with CVD who were enrolled in a clinical pharmacist-managed, physician-directed, CVD disease state management service. Clinical pharmacists were randomized to provide usual care (control) or BST (intervention) to their tobacco-using patients during a 4-month period. Patients were surveyed 3 months later to assess their tobacco cessation attempts, use of tobacco cessation aids, and self-reported cessation. One hundred twenty patients were enrolled. Subjects were predominately white males, aged ≥65 years, with a history of myocardial infarction. One hundred and four subjects completed the follow-up survey. No differences were detected between the 36.2% and 38.6% of control and intervention subjects, respectively, reporting a tobacco cessation attempt (P=0.804) or in the other outcomes (all P>0.05). A BST delivered by clinical pharmacists may not adequately affect patient motivation enough to increase tobacco cessation attempts in tobacco-dependent patients with CVD. Future research is needed to evaluate other team-based strategies that can decrease tobacco use in patients with CVD.
authors: 1 Exempla Lutheran Medical Center , Wheat Ridge, Colorado.
authors: Jody
authors: J
authors: Adams
authors: 2 Pharmacy Department, Kaiser Permanente Colorado , Aurora, Colorado.|3 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado , Aurora, Colorado.
authors: Alicia A
authors: AA
authors: Cymbala
authors: 2 Pharmacy Department, Kaiser Permanente Colorado , Aurora, Colorado.|3 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado , Aurora, Colorado.
authors: Thomas
authors: T
authors: Delate
authors: 2 Pharmacy Department, Kaiser Permanente Colorado , Aurora, Colorado.
authors: Deanna
authors: D
authors: Kurz
authors: 2 Pharmacy Department, Kaiser Permanente Colorado , Aurora, Colorado.|3 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado , Aurora, Colorado.
authors: Kari L
authors: KL
authors: Olson
authors: 2 Pharmacy Department, Kaiser Permanente Colorado , Aurora, Colorado.|3 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado , Aurora, Colorado.
authors: Morgan
authors: M
authors: Youngblood
authors: 2 Pharmacy Department, Kaiser Permanente Colorado , Aurora, Colorado.|3 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado , Aurora, Colorado.|4 School of Pharmacy, Regis University Reuckert-Hartman College for Health Professions , Denver, Colorado.
authors: Emily
authors: E
authors: Zadvorny
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000150:complications; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000627:therapeutic use*; D010595:Pharmacists; D011446:Prospective Studies; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000150:complications / Q000628:therapy*
chemical_list: D009538:Nicotine