Smoking cessation outcome in NCD clinic of Thailand community hospital: Pharmacist-led

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Piyawan Kuwalairat
Rarin Sornkate
Sunee Lertsinudom


Background: Smoking is the major risk for cardiovascular events in non-communicable chronic diseases; hypertension and diabetes. Smoking cessation is high effective intervention to reduce its morbidity and mortality. However clearly assessment for outcome in Thailand especially by pharmacist-led is scarce. Objectives: This study aim to assess the smoking cessation outcome, stage of change and cardiovascular disease (CVD) risk reduction at 1 year follow-up by pharmacist-led. Method: A quasi experiment prospective study recruited the current smoker with hypertension and diabetes at out-patient department Paknum-Chumphon hospital during January 2014 – January 2015. Baseline and follow-up measurement after 1, 2 weeks, 1, 2, 6 months and 1 year endpoint were performed. The primary outcomes were the interim quit rate, the reduction of number of cigarettes per day, fagerstrom score, stage of change and abstinence rate at 1 year of follow-up.  Secondary outcomes were Framingham 10-year CVD risk lowering. The statistical significant level (α) = 0.05. Results: The total of 176 patients, the majority were male and the average age were 55.5 years (SD=13.7). The number of patients with hypertension, diabetes and both were 59.7%, 33.5% and 6.8% respectively. The reduction of number of cigarettes per day and nicotine dependence level (fagerstrom score) in the follow-up duration were significant (One-way ANOVA p=0.001*, p=0.001*). The number of cigarette per day were decrease from 12.4 (SD=7.9) to 2.7 (SD=3.5) and stage of change were significantly changed to maintenance (X2-test p=0.001*).  Total abstinence rate at 1 year was 30.7%. Abstinence rate in patients with hypertension, diabetes and both were 30.1%, 32.2% and 33.3% respectively. The CVD risk reduction according to Framingham 10-year general cardiovascular risk score; at 1 year follow-up the patients with high risk level (20% - <30%) – very high risk level (30% - <40%) were reduced from 32.6% to 24.4%. The Framingham 10-year CVD risk score were significantly reduced both in patient with hypertension and diabetes and the average lowering were 15.26% (SD=7.79) to 13.54% (SD=7.32) (paired t-test p=0.001*). Conclusion: The pharmacist-led smoking cessation in non-communicable chronic diseases were effective in smoking cessation and harm reduction. That provided the benefit in CVD risk reduction.


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