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<option value="acoustics"> Acoustics </option>
<option value="amh"> Acta Microbiologica Hellenica (AMH) </option>
<option value="actuators"> Actuators </option>
<option value="admsci"> Administrative Sciences </option>
<option value="adolescents"> Adolescents </option>
<option value="arm"> Advances in Respiratory Medicine (ARM) </option>
<option value="aerobiology"> Aerobiology </option>
<option value="aerospace"> Aerospace </option>
<option value="agriculture"> Agriculture </option>
<option value="agriengineering"> AgriEngineering </option>
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<option value="agronomy"> Agronomy </option>
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<option value="air"> Air </option>
<option value="algorithms"> Algorithms </option>
<option value="allergies"> Allergies </option>
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<option value="analytica"> Analytica </option>
<option value="analytics"> Analytics </option>
<option value="anatomia"> Anatomia </option>
<option value="anesthres"> Anesthesia Research </option>
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<option value="antibiotics"> Antibiotics </option>
<option value="antibodies"> Antibodies </option>
<option value="antioxidants"> Antioxidants </option>
<option value="applbiosci"> Applied Biosciences </option>
<option value="applmech"> Applied Mechanics </option>
<option value="applmicrobiol"> Applied Microbiology </option>
<option value="applnano"> Applied Nano </option>
<option value="applsci"> Applied Sciences </option>
<option value="asi"> Applied System Innovation (ASI) </option>
<option value="appliedchem"> AppliedChem </option>
<option value="appliedmath"> AppliedMath </option>
<option value="aquacj"> Aquaculture Journal </option>
<option value="architecture"> Architecture </option>
<option value="arthropoda"> Arthropoda </option>
<option value="arts"> Arts </option>
<option value="astronomy"> Astronomy </option>
<option value="atmosphere"> Atmosphere </option>
<option value="atoms"> Atoms </option>
<option value="audiolres"> Audiology Research </option>
<option value="automation"> Automation </option>
<option value="axioms"> Axioms </option>
<option value="bacteria"> Bacteria </option>
<option value="batteries"> Batteries </option>
<option value="behavsci"> Behavioral Sciences </option>
<option value="beverages"> Beverages </option>
<option value="BDCC"> Big Data and Cognitive Computing (BDCC) </option>
<option value="biochem"> BioChem </option>
<option value="bioengineering"> Bioengineering </option>
<option value="biologics"> Biologics </option>
<option value="biology"> Biology </option>
<option value="blsf"> Biology and Life Sciences Forum </option>
<option value="biomass"> Biomass </option>
<option value="biomechanics"> Biomechanics </option>
<option value="biomed"> BioMed </option>
<option value="biomedicines"> Biomedicines </option>
<option value="biomedinformatics"> BioMedInformatics </option>
<option value="biomimetics"> Biomimetics </option>
<option value="biomolecules"> Biomolecules </option>
<option value="biophysica"> Biophysica </option>
<option value="biosensors"> Biosensors </option>
<option value="biotech"> BioTech </option>
<option value="birds"> Birds </option>
<option value="blockchains"> Blockchains </option>
<option value="brainsci"> Brain Sciences </option>
<option value="buildings"> Buildings </option>
<option value="businesses"> Businesses </option>
<option value="carbon"> C </option>
<option value="cancers"> Cancers </option>
<option value="cardiogenetics"> Cardiogenetics </option>
<option value="catalysts"> Catalysts </option>
<option value="cells"> Cells </option>
<option value="ceramics"> Ceramics </option>
<option value="challenges"> Challenges </option>
<option value="ChemEngineering"> ChemEngineering </option>
<option value="chemistry"> Chemistry </option>
<option value="chemproc"> Chemistry Proceedings </option>
<option value="chemosensors"> Chemosensors </option>
<option value="children"> Children </option>
<option value="chips"> Chips </option>
<option value="civileng"> CivilEng </option>
<option value="cleantechnol"> Clean Technologies (Clean Technol.) </option>
<option value="climate"> Climate </option>
<option value="ctn"> Clinical and Translational Neuroscience (CTN) </option>
<option value="clinbioenerg"> Clinical Bioenergetics </option>
<option value="clinpract"> Clinics and Practice </option>
<option value="clockssleep"> Clocks & Sleep </option>
<option value="coasts"> Coasts </option>
<option value="coatings"> Coatings </option>
<option value="colloids"> Colloids and Interfaces </option>
<option value="colorants"> Colorants </option>
<option value="commodities"> Commodities </option>
<option value="complications"> Complications </option>
<option value="compounds"> Compounds </option>
<option value="computation"> Computation </option>
<option value="csmf"> Computer Sciences & Mathematics Forum </option>
<option value="computers"> Computers </option>
<option value="condensedmatter"> Condensed Matter </option>
<option value="conservation"> Conservation </option>
<option value="constrmater"> Construction Materials </option>
<option value="cmd"> Corrosion and Materials Degradation (CMD) </option>
<option value="cosmetics"> Cosmetics </option>
<option value="covid"> COVID </option>
<option value="crops"> Crops </option>
<option value="cryo"> Cryo </option>
<option value="cryptography"> Cryptography </option>
<option value="crystals"> Crystals </option>
<option value="cimb"> Current Issues in Molecular Biology (CIMB) </option>
<option value="curroncol"> Current Oncology </option>
<option value="dairy"> Dairy </option>
<option value="data"> Data </option>
<option value="dentistry"> Dentistry Journal </option>
<option value="dermato"> Dermato </option>
<option value="dermatopathology"> Dermatopathology </option>
<option value="designs"> Designs </option>
<option value="diabetology"> Diabetology </option>
<option value="diagnostics"> Diagnostics </option>
<option value="dietetics"> Dietetics </option>
<option value="digital"> Digital </option>
<option value="disabilities"> Disabilities </option>
<option value="diseases"> Diseases </option>
<option value="diversity"> Diversity </option>
<option value="dna"> DNA </option>
<option value="drones"> Drones </option>
<option value="ddc"> Drugs and Drug Candidates (DDC) </option>
<option value="dynamics"> Dynamics </option>
<option value="earth"> Earth </option>
<option value="ecologies"> Ecologies </option>
<option value="econometrics"> Econometrics </option>
<option value="economies"> Economies </option>
<option value="education"> Education Sciences </option>
<option value="electricity"> Electricity </option>
<option value="electrochem"> Electrochem </option>
<option value="electronicmat"> Electronic Materials </option>
<option value="electronics"> Electronics </option>
<option value="ecm"> Emergency Care and Medicine </option>
<option value="encyclopedia"> Encyclopedia </option>
<option value="endocrines"> Endocrines </option>
<option value="energies"> Energies </option>
<option value="esa"> Energy Storage and Applications (ESA) </option>
<option value="eng"> Eng </option>
<option value="engproc"> Engineering Proceedings </option>
<option value="entropy"> Entropy </option>
<option value="eesp"> Environmental and Earth Sciences Proceedings </option>
<option value="environments"> Environments </option>
<option value="epidemiologia"> Epidemiologia </option>
<option value="epigenomes"> Epigenomes </option>
<option value="ebj"> European Burn Journal (EBJ) </option>
<option value="ejihpe"> European Journal of Investigation in Health, Psychology and Education (EJIHPE) </option>
<option value="fermentation"> Fermentation </option>
<option value="fibers"> Fibers </option>
<option value="fintech"> FinTech </option>
<option value="fire"> Fire </option>
<option value="fishes"> Fishes </option>
<option value="fluids"> Fluids </option>
<option value="foods"> Foods </option>
<option value="forecasting"> Forecasting </option>
<option value="forensicsci"> Forensic Sciences </option>
<option value="forests"> Forests </option>
<option value="fossstud"> Fossil Studies </option>
<option value="foundations"> Foundations </option>
<option value="fractalfract"> Fractal and Fractional (Fractal Fract) </option>
<option value="fuels"> Fuels </option>
<option value="future"> Future </option>
<option value="futureinternet"> Future Internet </option>
<option value="futurepharmacol"> Future Pharmacology </option>
<option value="futuretransp"> Future Transportation </option>
<option value="galaxies"> Galaxies </option>
<option value="games"> Games </option>
<option value="gases"> Gases </option>
<option value="gastroent"> Gastroenterology Insights </option>
<option value="gastrointestdisord"> Gastrointestinal Disorders </option>
<option value="gastronomy"> Gastronomy </option>
<option value="gels"> Gels </option>
<option value="genealogy"> Genealogy </option>
<option value="genes"> Genes </option>
<option value="geographies"> Geographies </option>
<option value="geohazards"> GeoHazards </option>
<option value="geomatics"> Geomatics </option>
<option value="geometry"> Geometry </option>
<option value="geosciences"> Geosciences </option>
<option value="geotechnics"> Geotechnics </option>
<option value="geriatrics"> Geriatrics </option>
<option value="glacies"> Glacies </option>
<option value="gucdd"> Gout, Urate, and Crystal Deposition Disease (GUCDD) </option>
<option value="grasses"> Grasses </option>
<option value="hardware"> Hardware </option>
<option value="healthcare"> Healthcare </option>
<option value="hearts"> Hearts </option>
<option value="hemato"> Hemato </option>
<option value="hematolrep"> Hematology Reports </option>
<option value="heritage"> Heritage </option>
<option value="histories"> Histories </option>
<option value="horticulturae"> Horticulturae </option>
<option value="hospitals"> Hospitals </option>
<option value="humanities"> Humanities </option>
<option value="humans"> Humans </option>
<option value="hydrobiology"> Hydrobiology </option>
<option value="hydrogen"> Hydrogen </option>
<option value="hydrology"> Hydrology </option>
<option value="hygiene"> Hygiene </option>
<option value="immuno"> Immuno </option>
<option value="idr"> Infectious Disease Reports </option>
<option value="informatics"> Informatics </option>
<option value="information"> Information </option>
<option value="infrastructures"> Infrastructures </option>
<option value="inorganics"> Inorganics </option>
<option value="insects"> Insects </option>
<option value="instruments"> Instruments </option>
<option value="iic"> Intelligent Infrastructure and Construction </option>
<option value="ijerph"> International Journal of Environmental Research and Public Health (IJERPH) </option>
<option value="ijfs"> International Journal of Financial Studies (IJFS) </option>
<option value="ijms"> International Journal of Molecular Sciences (IJMS) </option>
<option value="IJNS"> International Journal of Neonatal Screening (IJNS) </option>
<option value="ijpb"> International Journal of Plant Biology (IJPB) </option>
<option value="ijt"> International Journal of Topology </option>
<option value="ijtm"> International Journal of Translational Medicine (IJTM) </option>
<option value="ijtpp"> International Journal of Turbomachinery, Propulsion and Power (IJTPP) </option>
<option value="ime"> International Medical Education (IME) </option>
<option value="inventions"> Inventions </option>
<option value="IoT"> IoT </option>
<option value="ijgi"> ISPRS International Journal of Geo-Information (IJGI) </option>
<option value="J"> J </option>
<option value="jal"> Journal of Ageing and Longevity (JAL) </option>
<option value="jcdd"> Journal of Cardiovascular Development and Disease (JCDD) </option>
<option value="jcto"> Journal of Clinical & Translational Ophthalmology (JCTO) </option>
<option value="jcm"> Journal of Clinical Medicine (JCM) </option>
<option value="jcs"> Journal of Composites Science (J. Compos. Sci.) </option>
<option value="jcp"> Journal of Cybersecurity and Privacy (JCP) </option>
<option value="jdad"> Journal of Dementia and Alzheimer's Disease (JDAD) </option>
<option value="jdb"> Journal of Developmental Biology (JDB) </option>
<option value="jeta"> Journal of Experimental and Theoretical Analyses (JETA) </option>
<option value="jfb"> Journal of Functional Biomaterials (JFB) </option>
<option value="jfmk"> Journal of Functional Morphology and Kinesiology (JFMK) </option>
<option value="jof"> Journal of Fungi (JoF) </option>
<option value="jimaging"> Journal of Imaging (J. Imaging) </option>
<option value="jintelligence"> Journal of Intelligence (J. Intell.) </option>
<option value="jlpea"> Journal of Low Power Electronics and Applications (JLPEA) </option>
<option value="jmmp"> Journal of Manufacturing and Materials Processing (JMMP) </option>
<option value="jmse"> Journal of Marine Science and Engineering (JMSE) </option>
<option value="jmahp"> Journal of Market Access & Health Policy (JMAHP) </option>
<option value="jmp"> Journal of Molecular Pathology (JMP) </option>
<option value="jnt"> Journal of Nanotheranostics (JNT) </option>
<option value="jne"> Journal of Nuclear Engineering (JNE) </option>
<option value="ohbm"> Journal of Otorhinolaryngology, Hearing and Balance Medicine (JOHBM) </option>
<option value="jop"> Journal of Parks </option>
<option value="jpm"> Journal of Personalized Medicine (JPM) </option>
<option value="jpbi"> Journal of Pharmaceutical and BioTech Industry (JPBI) </option>
<option value="jor"> Journal of Respiration (JoR) </option>
<option value="jrfm"> Journal of Risk and Financial Management (JRFM) </option>
<option value="jsan"> Journal of Sensor and Actuator Networks (JSAN) </option>
<option value="joma"> Journal of the Oman Medical Association (JOMA) </option>
<option value="jtaer"> Journal of Theoretical and Applied Electronic Commerce Research (JTAER) </option>
<option value="jvd"> Journal of Vascular Diseases (JVD) </option>
<option value="jox"> Journal of Xenobiotics (JoX) </option>
<option value="jzbg"> Journal of Zoological and Botanical Gardens (JZBG) </option>
<option value="journalmedia"> Journalism and Media </option>
<option value="kidneydial"> Kidney and Dialysis </option>
<option value="kinasesphosphatases"> Kinases and Phosphatases </option>
<option value="knowledge"> Knowledge </option>
<option value="labmed"> LabMed </option>
<option value="laboratories"> Laboratories </option>
<option value="land"> Land </option>
<option value="languages"> Languages </option>
<option value="laws"> Laws </option>
<option value="life"> Life </option>
<option value="limnolrev"> Limnological Review </option>
<option value="lipidology"> Lipidology </option>
<option value="liquids"> Liquids </option>
<option value="literature"> Literature </option>
<option value="livers"> Livers </option>
<option value="logics"> Logics </option>
<option value="logistics"> Logistics </option>
<option value="lubricants"> Lubricants </option>
<option value="lymphatics"> Lymphatics </option>
<option value="make"> Machine Learning and Knowledge Extraction (MAKE) </option>
<option value="machines"> Machines </option>
<option value="macromol"> Macromol </option>
<option value="magnetism"> Magnetism </option>
<option value="magnetochemistry"> Magnetochemistry </option>
<option value="marinedrugs"> Marine Drugs </option>
<option value="materials"> Materials </option>
<option value="materproc"> Materials Proceedings </option>
<option value="mca"> Mathematical and Computational Applications (MCA) </option>
<option value="mathematics"> Mathematics </option>
<option value="medsci"> Medical Sciences </option>
<option value="msf"> Medical Sciences Forum </option>
<option value="medicina"> Medicina </option>
<option value="medicines"> Medicines </option>
<option value="membranes"> Membranes </option>
<option value="merits"> Merits </option>
<option value="metabolites"> Metabolites </option>
<option value="metals"> Metals </option>
<option value="meteorology"> Meteorology </option>
<option value="methane"> Methane </option>
<option value="mps"> Methods and Protocols (MPs) </option>
<option value="metrics"> Metrics </option>
<option value="metrology"> Metrology </option>
<option value="micro"> Micro </option>
<option value="microbiolres"> Microbiology Research </option>
<option value="micromachines"> Micromachines </option>
<option value="microorganisms"> Microorganisms </option>
<option value="microplastics"> Microplastics </option>
<option value="minerals"> Minerals </option>
<option value="mining"> Mining </option>
<option value="modelling"> Modelling </option>
<option value="mmphys"> Modern Mathematical Physics </option>
<option value="molbank"> Molbank </option>
<option value="molecules"> Molecules </option>
<option value="mti"> Multimodal Technologies and Interaction (MTI) </option>
<option value="muscles"> Muscles </option>
<option value="nanoenergyadv"> Nanoenergy Advances </option>
<option value="nanomanufacturing"> Nanomanufacturing </option>
<option value="nanomaterials"> Nanomaterials </option>
<option value="ndt"> NDT </option>
<option value="network"> Network </option>
<option value="neuroglia"> Neuroglia </option>
<option value="neurolint"> Neurology International </option>
<option value="neurosci"> NeuroSci </option>
<option value="nitrogen"> Nitrogen </option>
<option value="ncrna"> Non-Coding RNA (ncRNA) </option>
<option value="nursrep"> Nursing Reports </option>
<option value="nutraceuticals"> Nutraceuticals </option>
<option value="nutrients"> Nutrients </option>
<option value="obesities"> Obesities </option>
<option value="oceans"> Oceans </option>
<option value="onco"> Onco </option>
<option value="optics"> Optics </option>
<option value="oral"> Oral </option>
<option value="organics"> Organics </option>
<option value="organoids"> Organoids </option>
<option value="osteology"> Osteology </option>
<option value="oxygen"> Oxygen </option>
<option value="parasitologia"> Parasitologia </option>
<option value="particles"> Particles </option>
<option value="pathogens"> Pathogens </option>
<option value="pathophysiology"> Pathophysiology </option>
<option value="pediatrrep"> Pediatric Reports </option>
<option value="pets"> Pets </option>
<option value="pharmaceuticals"> Pharmaceuticals </option>
<option value="pharmaceutics"> Pharmaceutics </option>
<option value="pharmacoepidemiology"> Pharmacoepidemiology </option>
<option value="pharmacy" selected="selected"> Pharmacy </option>
<option value="philosophies"> Philosophies </option>
<option value="photochem"> Photochem </option>
<option value="photonics"> Photonics </option>
<option value="phycology"> Phycology </option>
<option value="physchem"> Physchem </option>
<option value="psf"> Physical Sciences Forum </option>
<option value="physics"> Physics </option>
<option value="physiologia"> Physiologia </option>
<option value="plants"> Plants </option>
<option value="plasma"> Plasma </option>
<option value="platforms"> Platforms </option>
<option value="pollutants"> Pollutants </option>
<option value="polymers"> Polymers </option>
<option value="polysaccharides"> Polysaccharides </option>
<option value="populations"> Populations </option>
<option value="poultry"> Poultry </option>
<option value="powders"> Powders </option>
<option value="proceedings"> Proceedings </option>
<option value="processes"> Processes </option>
<option value="prosthesis"> Prosthesis </option>
<option value="proteomes"> Proteomes </option>
<option value="psychiatryint"> Psychiatry International </option>
<option value="psychoactives"> Psychoactives </option>
<option value="psycholint"> Psychology International </option>
<option value="publications"> Publications </option>
<option value="qubs"> Quantum Beam Science (QuBS) </option>
<option value="quantumrep"> Quantum Reports </option>
<option value="quaternary"> Quaternary </option>
<option value="radiation"> Radiation </option>
<option value="reactions"> Reactions </option>
<option value="realestate"> Real Estate </option>
<option value="receptors"> Receptors </option>
<option value="recycling"> Recycling </option>
<option value="rsee"> Regional Science and Environmental Economics (RSEE) </option>
<option value="religions"> Religions </option>
<option value="remotesensing"> Remote Sensing </option>
<option value="reports"> Reports </option>
<option value="reprodmed"> Reproductive Medicine (Reprod. Med.) </option>
<option value="resources"> Resources </option>
<option value="rheumato"> Rheumato </option>
<option value="risks"> Risks </option>
<option value="robotics"> Robotics </option>
<option value="ruminants"> Ruminants </option>
<option value="safety"> Safety </option>
<option value="sci"> Sci </option>
<option value="scipharm"> Scientia Pharmaceutica (Sci. Pharm.) </option>
<option value="sclerosis"> Sclerosis </option>
<option value="seeds"> Seeds </option>
<option value="sensors"> Sensors </option>
<option value="separations"> Separations </option>
<option value="sexes"> Sexes </option>
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<option value="108091">Pharmacy Reviews in 2022</option>
<option value="31284">A Prescription to Optimize Cancer Care: The Expanding Role of the Oncology Pharmacist </option>
<option value="115062">Advances in Cardiovascular Disease Management by Pharmacists</option>
<option value="29900">Advances in Pharmaceutical Care</option>
<option value="42623">Allergic Disease: Integrated Management by The Pharmacist</option>
<option value="145244">Antimicrobial Adverse Reaction and Drug-Drug Interactions</option>
<option value="32155">Antimicrobial Stewardship across the Continuum of Care</option>
<option value="31944">Atrial Fibrillation Management in Pharmacy</option>
<option value="5862">Clinical Pharmacy</option>
<option value="45134">Communication About Medicines</option>
<option value="9615">Communication in Pharmacy Practice</option>
<option value="24676">Community Pharmacists and Optimization of Patient Medication Use</option>
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<option value="44417">Consumers’ and Caregivers’ Perceptions of Pharmacist Services</option>
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<option value="27599">Data and Development: Drug Utilisation, Pharmacoepidemiology and Health Technology Assessment</option>
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<option value="154816">Digital Health in Pharmacy Practice and Education</option>
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<option value="221486">Enhancing Mental Health and Well-Being in Pharmacy Students: Challenges and Interventions</option>
<option value="11429">European Conference on Health Workforce Education and Research 2018</option>
<option value="121113">Expanding Pharmacists’ Role in Primary Care Setting among Rural and Low-Income Communities</option>
<option value="24656">Health Inequality and Pharmacy</option>
<option value="8433">Health Services Research in the Use of Medicines</option>
<option value="27969">History of Medicine, an Essential and Evergreen Tool for Health Scientists</option>
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<option value="8638">Impact of Pharmacists in the Community Setting</option>
<option value="14690">Improving Medication Safety: Role of Providers, Patients and Technology</option>
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<option value="34933">Long Term Care Pharmacy and Senior Care Pharmacy Policy</option>
<option value="8089">Maximising the Contribution of Community Pharmacists in Self-care</option>
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<option value="38775">Medication Use of Patients in Hemodialysis Patients</option>
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<option value="20962">Novel Systems in Health Care Delivery: Leadership at its Finest</option>
<option value="2335">Online Learning</option>
<option value="16383">Optimising Medicines in Care Homes</option>
<option value="51280">Over-the-Counter (OTC) Medicines Use</option>
<option value="11043">Palliative Care</option>
<option value="47693">Partnering Patients and Interprofessionalism for Pharmacy Service Innovation</option>
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<option value="10119">Patient Safety and Adverse Drug Events in Medication Practice</option>
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<option value="42918">Pharmaceutical Health Services and Outcomes Research</option>
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<option value="179202">Pharmacist Workforce Challenges and Solutions: Insights from Research and Practice</option>
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<option value="36217">Pharmacists as Immunizers: The Role of Pharmacies in Promoting Immunization Campaigns and Counteracting Vaccine Hesitancy</option>
<option value="8038">Pharmacists Bridging the Gap and Optimizing Care for Substance Use Disorder Patients</option>
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<option value="37124">Pharmacists’ Role in Blood Pressure Control</option>
<option value="7567">Pharmacists’ Role in Improving Medication Use and Health Outcomes</option>
<option value="34080">Pharmacists’ Roles in Sexually Transmitted and Blood-Borne Infections</option>
<option value="218298">Pharmacovigilance and Pharmacists’ Role</option>
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<option value="20685">Pharmacy-based Immunization Services</option>
<option value="184779">Pharmacy: State of the Art and Perspectives in USA (2nd Edition)</option>
<option value="113628">Pharmacy: State-of-the-Art and Perspectives in UK</option>
<option value="111177">Pharmacy: State-of-the-Art and Perspectives in USA</option>
<option value="32707">Polypharmacy</option>
<option value="57308">PRN Medicines Management</option>
<option value="11934">Proceedings of the Singapore National Clinical Pharmacy Colloquium – Health Manpower Development Planning</option>
<option value="178720">Professional Ethics in Pharmacy: Exploring Contemporary Challenges and Future Directions</option>
<option value="20199">Psychotropic Medication Adherence</option>
<option value="9774">Qualitative Methods in Pharmacy Research</option>
<option value="20259">Quality Use of Medicine in Aged Care Homes</option>
<option value="16261">Rare and Imported Paediatric Infections</option>
<option value="31951">Reflective Practice beyond Pharmacy Education: A Move towards Interprofessional Reflective Practice</option>
<option value="32613">Responsible Use of Opioids</option>
<option value="2841">Rural and Regional Pharmacy Education and Leadership</option>
<option value="2635">Simulation in Pharmacy Education</option>
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<option value="56621">Small Molecular Medicines Market Analysis</option>
<option value="5128">Social Pharmacy</option>
<option value="25650">Supporting Vulnerable and Medically Underserved Groups through Community Pharmacy</option>
<option value="165500">Sustainability of Community and Clinical Pharmacy Services in Public Health</option>
<option value="176458">Sustainability of Pharmacy Oncology Education and Practice</option>
<option value="52304">Technology Learning Strategies</option>
<option value="34059">Technology-Enabled Provision of Pharmacy Services</option>
<option value="101471">The 10th Anniversary of Pharmacy—Advances in Pharmacy Education and Practice</option>
<option value="217093">The AI Revolution in Pharmacy Practice and Education</option>
<option value="16549">The Burden of Medicines</option>
<option value="112886">The Emerging Role of Pharmacists in Pharmacogenomics</option>
<option value="11629">The Labor Market for Pharmacists</option>
<option value="169390">The Pharmacist’s Role in Antimicrobial Stewardship and Use</option>
<option value="19174">The Role of Community Pharmacists in Public Health</option>
<option value="12501">The Standing of OTC Medicines in Community Practice</option>
<option value="13614">Travel Medicine - Series Ⅰ</option>
<option value="27332">Travel Medicine - Series Ⅱ</option>
<option value="35974">Value-Based Care Through Community Pharmacy Partnerships</option>
<option value="186863">Women's Special Issue Series: Pharmacy and Pharmacists</option>
<option value="108627">Women’s Special Issue Series: Pharmacy</option>
<option value="5214">Workplace Learning in Pharmacy</option>
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<option value="ebj">European Burn Journal</option>
<option value="ejihpe">European Journal of Investigation in Health, Psychology and Education</option>
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<option value="ijerph">International Journal of Environmental Research and Public Health</option>
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<option value="ijgi">ISPRS International Journal of Geo-Information</option>
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<option value="jal">Journal of Ageing and Longevity</option>
<option value="jcdd">Journal of Cardiovascular Development and Disease</option>
<option value="jcto">Journal of Clinical & Translational Ophthalmology</option>
<option value="jcm">Journal of Clinical Medicine</option>
<option value="jcs">Journal of Composites Science</option>
<option value="jcp">Journal of Cybersecurity and Privacy</option>
<option value="jdad">Journal of Dementia and Alzheimer's Disease</option>
<option value="jdb">Journal of Developmental Biology</option>
<option value="jeta">Journal of Experimental and Theoretical Analyses</option>
<option value="jfb">Journal of Functional Biomaterials</option>
<option value="jfmk">Journal of Functional Morphology and Kinesiology</option>
<option value="jof">Journal of Fungi</option>
<option value="jimaging">Journal of Imaging</option>
<option value="jintelligence">Journal of Intelligence</option>
<option value="jlpea">Journal of Low Power Electronics and Applications</option>
<option value="jmmp">Journal of Manufacturing and Materials Processing</option>
<option value="jmse">Journal of Marine Science and Engineering</option>
<option value="jmahp">Journal of Market Access & Health Policy</option>
<option value="jmp">Journal of Molecular Pathology</option>
<option value="jnt">Journal of Nanotheranostics</option>
<option value="jne">Journal of Nuclear Engineering</option>
<option value="ohbm">Journal of Otorhinolaryngology, Hearing and Balance Medicine</option>
<option value="jop">Journal of Parks</option>
<option value="jpm">Journal of Personalized Medicine</option>
<option value="jpbi">Journal of Pharmaceutical and BioTech Industry</option>
<option value="jor">Journal of Respiration</option>
<option value="jrfm">Journal of Risk and Financial Management</option>
<option value="jsan">Journal of Sensor and Actuator Networks</option>
<option value="joma">Journal of the Oman Medical Association</option>
<option value="jtaer">Journal of Theoretical and Applied Electronic Commerce Research</option>
<option value="jvd">Journal of Vascular Diseases</option>
<option value="jox">Journal of Xenobiotics</option>
<option value="jzbg">Journal of Zoological and Botanical Gardens</option>
<option value="journalmedia">Journalism and Media</option>
<option value="kidneydial">Kidney and Dialysis</option>
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<option value="lubricants">Lubricants</option>
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<option value="make">Machine Learning and Knowledge Extraction</option>
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<option value="magnetism">Magnetism</option>
<option value="magnetochemistry">Magnetochemistry</option>
<option value="marinedrugs">Marine Drugs</option>
<option value="materials">Materials</option>
<option value="materproc">Materials Proceedings</option>
<option value="mca">Mathematical and Computational Applications</option>
<option value="mathematics">Mathematics</option>
<option value="medsci">Medical Sciences</option>
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<option value="medicina">Medicina</option>
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<option value="metabolites">Metabolites</option>
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<option value="methane">Methane</option>
<option value="mps">Methods and Protocols</option>
<option value="metrics">Metrics</option>
<option value="metrology">Metrology</option>
<option value="micro">Micro</option>
<option value="microbiolres">Microbiology Research</option>
<option value="micromachines">Micromachines</option>
<option value="microorganisms">Microorganisms</option>
<option value="microplastics">Microplastics</option>
<option value="minerals">Minerals</option>
<option value="mining">Mining</option>
<option value="modelling">Modelling</option>
<option value="mmphys">Modern Mathematical Physics</option>
<option value="molbank">Molbank</option>
<option value="molecules">Molecules</option>
<option value="mti">Multimodal Technologies and Interaction</option>
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<option value="nanoenergyadv">Nanoenergy Advances</option>
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<option value="neuroglia">Neuroglia</option>
<option value="neurolint">Neurology International</option>
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<option value="ncrna">Non-Coding RNA</option>
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<option value="obesities">Obesities</option>
<option value="oceans">Oceans</option>
<option value="onco">Onco</option>
<option value="optics">Optics</option>
<option value="oral">Oral</option>
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<option value="organoids">Organoids</option>
<option value="osteology">Osteology</option>
<option value="oxygen">Oxygen</option>
<option value="parasitologia">Parasitologia</option>
<option value="particles">Particles</option>
<option value="pathogens">Pathogens</option>
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<option value="pediatrrep">Pediatric Reports</option>
<option value="pets">Pets</option>
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<option value="philosophies">Philosophies</option>
<option value="photochem">Photochem</option>
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<option value="physchem">Physchem</option>
<option value="psf">Physical Sciences Forum</option>
<option value="physics">Physics</option>
<option value="physiologia">Physiologia</option>
<option value="plants">Plants</option>
<option value="plasma">Plasma</option>
<option value="platforms">Platforms</option>
<option value="pollutants">Pollutants</option>
<option value="polymers">Polymers</option>
<option value="polysaccharides">Polysaccharides</option>
<option value="populations">Populations</option>
<option value="poultry">Poultry</option>
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<option value="proceedings">Proceedings</option>
<option value="processes">Processes</option>
<option value="prosthesis">Prosthesis</option>
<option value="proteomes">Proteomes</option>
<option value="psychiatryint">Psychiatry International</option>
<option value="psychoactives">Psychoactives</option>
<option value="psycholint">Psychology International</option>
<option value="publications">Publications</option>
<option value="qubs">Quantum Beam Science</option>
<option value="quantumrep">Quantum Reports</option>
<option value="quaternary">Quaternary</option>
<option value="radiation">Radiation</option>
<option value="reactions">Reactions</option>
<option value="realestate">Real Estate</option>
<option value="receptors">Receptors</option>
<option value="recycling">Recycling</option>
<option value="rsee">Regional Science and Environmental Economics</option>
<option value="religions">Religions</option>
<option value="remotesensing">Remote Sensing</option>
<option value="reports">Reports</option>
<option value="reprodmed">Reproductive Medicine</option>
<option value="resources">Resources</option>
<option value="rheumato">Rheumato</option>
<option value="risks">Risks</option>
<option value="robotics">Robotics</option>
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<option value="safety">Safety</option>
<option value="sci">Sci</option>
<option value="scipharm">Scientia Pharmaceutica</option>
<option value="sclerosis">Sclerosis</option>
<option value="seeds">Seeds</option>
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<option value="separations">Separations</option>
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<option value="signals">Signals</option>
<option value="sinusitis">Sinusitis</option>
<option value="smartcities">Smart Cities</option>
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<option value="siuj">Société Internationale d’Urologie Journal</option>
<option value="societies">Societies</option>
<option value="software">Software</option>
<option value="soilsystems">Soil Systems</option>
<option value="solar">Solar</option>
<option value="solids">Solids</option>
<option value="spectroscj">Spectroscopy Journal</option>
<option value="sports">Sports</option>
<option value="standards">Standards</option>
<option value="stats">Stats</option>
<option value="stresses">Stresses</option>
<option value="surfaces">Surfaces</option>
<option value="surgeries">Surgeries</option>
<option value="std">Surgical Techniques Development</option>
<option value="sustainability">Sustainability</option>
<option value="suschem">Sustainable Chemistry</option>
<option value="symmetry">Symmetry</option>
<option value="synbio">SynBio</option>
<option value="systems">Systems</option>
<option value="targets">Targets</option>
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<option value="thalassrep">Thalassemia Reports</option>
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<option value="tourismhosp">Tourism and Hospitality</option>
<option value="toxics">Toxics</option>
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<option value="higheredu">Trends in Higher Education</option>
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<option value="universe">Universe</option>
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<option value="wild">Wild</option>
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<option value="world">World</option>
<option value="wevj">World Electric Vehicle Journal</option>
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Open AccessArticle
SMOKING CESSATION AT THE COMMUNITY PHARMACY: DETERMINANTS OF SUCCESS FROM A
REAL-LIFE PRACTICE
by
Mónica Condinho
Mónica Condinho
SciProfiles Scilit Preprints.org Google Scholar
1,2,
Isabel Ramalhinho
Isabel Ramalhinho
SciProfiles Scilit Preprints.org Google Scholar
2,* and
Carlos Sinogas
Carlos Sinogas
SciProfiles Scilit Preprints.org Google Scholar
1,3
1
AcF—Acompanhamento Farmacoterapêutico Lda, 7490-324 Pavia, Portugal
2
Faculdade de Ciências e Tecnologia, Universidade do Algarve, 8005-139 Faro,
Portugal
3
Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7000-671 Évora,
Portugal
*
Author to whom correspondence should be addressed.
Pharmacy 2021, 9(3), 143; https://doi.org/10.3390/pharmacy9030143
Submission received: 14 June 2021 / Revised: 29 July 2021 / Accepted: 13 August
2021 / Published: 19 August 2021
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ABSTRACT
The objectives of this study are to report the contribution of pharmacists to
smoking cessation and study the determinants of smoking cessation success in
eight pharmacies in Portugal (south) between 2009 and 2019. A real-life study
was conducted with a sample of smokers who participated in pharmacist
consultations. The sample included 135 smokers (average age of 47.9 ± 1.21
years), 79 (58.5%) of whom were male. In parallel with the motivation and
behavioral approach, 116 (85.9%) smokers received pharmacological therapies: 108
(80.0%) were treated with nicotine replacement products and eight (5.9%) with
non-nicotine medications. The interventions resulted in 70 (51.9%) smokers
complying with the quit day, of whom 59 (43.7%) were smoking-abstinent at the
end of the first month. Success rates were reduced to 32.6%, 28.1%, and 20.7% at
the end of the 3rd, 6th, and 12th months, respectively. Smoking cessation was
more successful for the participants receiving pharmacological therapies
(Fisher’s exact test, p < 0.001) and those who participated in more pharmacist
consultations (χ2 = 59.994, p < 0.001) and more telephone sessions (χ2 = 17.845,
p < 0.001). Pharmacists can contribute significantly to the promotion of smoking
cessation. Smokers who are more thoroughly followed up by pharmacists showed
increased success rates when compared with smokers having fewer sessions with
pharmacists.
Keywords:
smoking cessation; determinants; community pharmacy; pharmacist; Portugal
1. INTRODUCTION
According to the Institute for Health Metrics and Evaluation, in 2017, 13,104
people in Portugal died due to causes attributable to tobacco use [1]. Nicotine
dependence contributed to 19.6% of deaths from cancer, 28.1% of deaths from
chronic respiratory disease, 8.7% of deaths from cerebrovascular disease and
9.8% of deaths from diabetes mellitus [1]. Despite these numbers, tobacco
consumption continues to be dramatically high in Portugal, representing a
significant public health problem. According to the 6th National Health Survey,
in 2019, 17.0% of the Portuguese population over 15 years of age were smokers
[2].
Based on several national studies, there seems to be a trend in increased
motivation to quit smoking, although few people seek professional help to do so
[3]. Compared to the previous year, in 2018, there was a 4.6% increase in the
number of National Health System service locations providing intensive support
for smoking cessation. The number of consultations and people attending these
consultations increased by 11% and 13.2%, respectively. Furthermore, there was
an increase in the dispensing of first-line drugs in community pharmacies to
support smoking cessation [3].
However, despite such efforts, there is still a high prevalence of consumption
and low cessation success rates [4]. To address this situation, it is important
that health professionals in different work settings collaborate to promote
smoking cessation and abstinence. Community pharmacists can contribute [5] due
to their closeness to the population (from the youngest to the oldest),
accessibility, and ability to regularly reinforce smoking cessation
interventions [6,7].
The aim of this work is to report on pharmacists’ contribution to smoking
cessation and study the determinants for smoking cessation success in the
community pharmacy setting.
2. MATERIALS AND METHODS
This is a real-life study of a sample of smokers who participated in pharmacist
consultations for smoking cessation in eight community pharmacies in the south
of Portugal between 2009 and 2019. The consultations were performed by an
outsourced trained pharmacist, who received post-graduate training in smoking
cessation. Smokers were invited to join the program during the usual activities
of the pharmacy according to the following inclusion criteria:
* Being 18 years of age or older;
* Being a smoker;
* Expressed willingness to quit smoking; and
* Signed the informed consent form.
The smoking cessation program followed the recommendations of the Portuguese
Directorate-General of Health [8]. These recommendations include face-to-face
consultations and telephone contact (see Table 1 for a detailed description).
Motivation was assessed by the Richmond test (weak (0–5); moderate (6–8); high
(9,10)) [9] and dependence by the Fagerström test (low (0–3); medium (4–6); high
(7–10)) [10]. Anxiety/depression signs and symptoms were assessed using the
Hospital Anxiety and Depression Scale [11]. The pharmaceutical intervention
focused on the motivational and behavioral approach [12] and on the prescription
of pharmacological therapy (nicotine replacement products: patches, gums,
lozenges, oral spray), based on the updated guidelines of the European Network
for Smoking and Tobacco Prevention [13,14,15]. When necessary, smokers were
referred to the physician by a written report. All participants received a type
3 medication review (according to Pharmaceutical Care Network Europe) from the
pharmacist [16]. The care plan was personalized and centered on smoking
cessation. However, when applicable, the pharmacist proposed interventions to
solve other health problems. Cardiovascular diseases received special attention
because tobacco consumption is an important risk factor. Other risk factors
(e.g., dyslipidemia) were also evaluated.
Table 1. Description of face-to-face consultations and telephone sessions.
Anthropometric data (weight, height, waist circumference), blood pressure, and
respiratory function by simple spirometry using Spirobank II Basic™ (Medical
International Research, Roma, Italy) were also evaluated and monitored.
The smoking abstinence rate was evaluated on D-Day (quit day) and at the end of
the 1st, 3rd, 6th, and 12th months. Abstinence was confirmed by measuring the
carbon monoxide levels in exhaled air using the GCO 100™ gas meter (Greinsinger
Electronic GmbH, Regenstauf, Germany).
The applied smoking cessation program also included “follow-up after smoking
cessation”. This follow-up benefitted from the fact that the patient usually
continued to attend the community pharmacy for reasons other than smoking
cessation consultation. Thus, each time the ex-smoker visited, it was possible
to evaluate the risk of relapse and highlight the benefits of smoking cessation,
promoting the maintenance of abstinence. Statistical analysis of the results was
performed using SPSS statistical analysis software (IBM SPSS V25; IBM Corp,
Armonk, NY, USA). For quantitative variables, measures of central tendency and
dispersion measures were calculated, and for qualitative variables, relative and
absolute frequencies were determined. Several bivariate analyses were performed,
using the χ2 test and Fisher’s exact test. A type I error probability (α) of
0.05 was considered in all inferential analyses. Mean values are presented as
mean ± standard error of the mean.
ETHICS ISSUES
Because the pharmacist in charge of patient care (M. Condinho) extracted the
data from the records, and as this action has no influence on the previous
smoking cessation care process, Portuguese legislation does not require the
submission of this project for ethics approval. All data were anonymized for
everyone else on the research team.
3. RESULTS
The study was conducted on a sample of smokers participating in pharmacist
consultations in eight community pharmacies over a period of ten years. The
characteristics of the patients are presented in Table 2. A total of 135
patients were included in the study, 79 (58.5%) of whom were male. The
participants’ ages ranged from 21 to 81 years (mean: 47.9 ± 1.21 years, median:
46.4 years). Regarding their state of health, the most prevalent comorbidities
were overweight (60%), dyslipidemia (48.9%), anxiety (30.4%), and hypertension
(29.9%).
Table 2. Characteristics of the enrolled patients.
Each patient participated in an average of 3.5 ± 0.28 pharmacist consultations
and 2.81 ± 0.31 telephone sessions over a period of 12 months. During the
consultations, more than 50% of the participants showed a moderate level of
motivation to quit smoking, and their level of nicotine dependence was
classified as medium (43.0%) or high (28.9%).
Regarding tobacco habits, during the first consultation, the participants
reported smoking an average of 22.5 ± 0.98 cigarettes per day, with an average
amount of time spent on tobacco consumption of 31.0 ± 1.24 years and an average
of 1.35 ± 0.10 attempts to quit smoking. The motivational and behavioral
approach was used in all pharmacist consultations. Of the 135 patients, 118
(87.4%) decided to quit tobacco with the support of pharmacological methods and
17 (12.6%) without pharmacological therapy. Nicotine replacement products were
recommended in 110 cases (81.5%), and non-nicotine therapy was used by eight
(5.9%) patients. Nicotine replacement products were used in oral forms by 54
patients, while 11 (10.0%) used transdermal forms, 29 used oral and transdermal
forms, and 16 (14.5%) used oral forms, followed by transdermal forms.
Figure 1 shows the smoking cessation success rates as a result of pharmacist
intervention. Of the 135 smokers who set a day to quit tobacco use, 59 (43.7%)
quit tobacco one month after. The quit smoking rate decreased to 32.6% after
three months, 28.1% after six months, and 20.7% after 12 months.
Figure 1. Abstinence rate (n = 135).
The success rate measured by the number of smokers who quit tobacco was not
significantly associated with sociodemographic variables such as age, gender,
and education. Likewise, this rate was not affected by motivation for smoking
cessation or the level of nicotine dependence (p > 0.05).
Smoking cessation success was significantly more frequent among patients who
underwent pharmacological therapy (Fisher’s exact test, p < 0.001) and those who
participated in more consultations (χ2 = 59.994, p < 0.001) and a greater number
of telephone sessions (χ2 = 17.845, p < 0.001) (Table 3). Likewise, success was
positively related to the presence of dyslipidemia (Fisher’s exact test, p <
0.001) and the existence of smoking habits for more than 40 years (χ2 = 12.403,
p = 0.013). Conversely, the success rate was lower in patients with depression
(Fisher’s exact test, p = 0.018). Anxious patients also had a lower success
rate, although the association was not statistically significant (Fisher’s exact
test, p = 0.060).
Table 3. Factors influencing smoking cessation success.
4. DISCUSSION
Our study corroborates previously published data [5] that consider the community
pharmacist a professional who can effectively contribute to the promotion of
smoking cessation, increasing abstinence rates. Despite the different natures
and study designs of the published interventions (motivational support only or
combined with nicotine and non-nicotine drugs), our results are encouraging,
with similar [17] or higher [18,19,20] abstinence rates at 6-and 12-month
follow-up. However, we recognize that further research is needed with
higher-quality evidence.
Regarding the factors that influence the success of smoking cessation, in our
study, success was significantly more frequent among patients who underwent
pharmacological therapies as well as among those who participated in more
consultations and telephone sessions. Indeed, the literature correlates the
success of smoking cessation programs with the frequency with which smokers
complete them [21], which overlaps with greater contact with the health
professional throughout follow-up (several visits or telephone sessions).
In our study, we also found that the abstinence rate was higher among patients
with dyslipidemia. Other published studies have shown divergent results
regarding the association between smoking cessation success rates and the
presence of chronic diseases [22,23]. As dyslipidemia is an important
cardiovascular risk factor and considering that the risk reduction argument was
used in the context of promoting the smoking cessation program, our findings may
be related to a greater awareness on the part of smokers about the risk of
cardiovascular disease. However, the success rate was lower in patients with
depression, which is consistent with data reported in the literature [23,24].
The relatively small sample size may be due to the smoking population’s lack of
knowledge about the existence of smoking cessation programs in community
pharmacies, which limits demand. It could also be explained by the insufficient
awareness of pharmacy professionals regarding the potential of community
pharmacists and pharmacies to promote smoking cessation. The typically weak
involvement of pharmacies in tobacco control policies in Portugal should also be
considered as an additional factor that could explain these data.
The biggest limitation of the present study is the absence of a control group.
Controlled and randomized studies are the gold standard for evaluating the
impact of any intervention. However, it is important to bear in mind that the
study resulted from a service implemented in community pharmacy practice, so it
is a real-life study. In fact, this study was not designed as a research study;
rather, it is the result of the professional activity of the authors.
Since the selection of participants could not be carried out according to
sampling rules that guarantee the representativeness of the study population,
the characteristics of our sample do not totally overlap with the national
reality, and thus our results cannot be generalized. Even so, they add
scientific evidence about the contribution of pharmacists to the promotion of
smoking cessation in the community pharmacy environment.
Regarding the characterization of the sample, the fact that the majority (58.5%)
is male is consistent with the national reality, as the prevalence of smokers is
higher in males than in females [2]. Conversely, the age group of the smokers
was not in agreement with the national data. While at the national level the
highest prevalence of smokers occurs in the 35–44 year age group (21.8%) [2], in
our study, most of the participants were 40–59 years of age (44.4%). This could
be because people over 40 tend to be more aware of tobacco-related diseases and
more susceptible to the occurrence of chronic diseases than younger groups, for
whom concerns about health problems are less significant. Thus, it is expected
that the demand for smoking cessation intervention in pharmacies or requests for
advice would be more common for people over the age of 40. The recruitment of
participants to include in this study also justifies this higher prevalence.
Analyzing the motivation of the study participants, as would be expected by the
inclusion criteria, most had moderate (53.3%) or high (20.7%) motivation, which
is inconsistent with the national data, in which motivation is more evenly
divided between low (41.7%) and moderate (41.3%) motivation. At the national
level, only a small percentage of smokers indicate high motivation (17%) to quit
smoking [25].
Regarding daily cigarette consumption, the average consumption in our sample
(22.5 ± 0.98 cigarettes) was higher than that reported in the last National
Health Survey [2]. This can be justified by the fact that, in our study, the
average age of the smokers was close to 50 years, with an average smoking
duration of more than 30 years, a high prevalence of comorbidities (including
anxiety) and, therefore, possibly greater dependence. It should be noted that
the average consumption recorded in our study, unlike that recorded in the
smoking population at the national level, was similar to that recorded in
another study carried out in Portugal with a similar sample [26], which confirms
our data.
The most prevalent pathologies in our sample are in agreement with the most
prevalent pathologies at the national level, although with different relative
percentages [27]. The success rates reported in the literature reveal discrepant
values, which, in some cases, makes our success rates more favorable than in
other cases. Our success rate after one month (43.7%) compared favorably with
others reported in the literature, ranging between 22% [28] and 26% [29]. After
three months (32.6%), it was unfavorable when compared to another study (58%)
[21]. After six months (28.1%), it was slightly higher or similar to some
published studies (18%, 25%, and 28%, respectively) [17,30,31] and lower
compared to another one [32]. After 12 months (20.7%), our success rate was
still higher when compared to some studies [28,33], but lower compared to others
(45%) [21]. This discrepancy can be explained by different study designs and
sample sizes, but above all, it seems to be related to the study setting. The
studies in which abstinence rates were more favorable were conducted in medical
clinics, with varenicline (the most effective drug in monotherapy [34]) being
the most commonly prescribed drug [21,32]. In fact, this therapeutic option is
not available to pharmacists in Portugal, which justifies the use, almost
entirely, of nicotine replacement therapy in our study. It is understandable
that when the immediate use of varenicline is available, due to the convenience
of taking it and the fact that it is already a reimbursed drug in many countries
(including Portugal), the choice of this drug contributes to smoking cessation
success. However, therapy with nicotine substitutes requires more attention in
use and administration and is more expensive [26]. This could contribute to
lower abstinence rates compared to cessation programs where varenicline is
available by direct prescription.
Nevertheless, when we compared our results with those of similar smoking
cessation programs in community pharmacies elsewhere [17,28,29,30,31], our
abstinence rates were quite favorable and encouraging. Thus, considering the
high prevalence of tobacco consumption in Portugal, the high burden of
associated diseases, and the need for the involvement of all health
professionals in tobacco control, our data should encourage the implementation
of smoking cessation programs in community pharmacies.
5. CONCLUSIONS
Based on the results of this study, community pharmacists can contribute
significantly to the promotion of smoking cessation. Smokers who were thoroughly
followed up by pharmacists had increased success rates compared to smokers who
had fewer sessions with pharmacists.
AUTHOR CONTRIBUTIONS
Conceptualization, M.C. and C.S.; Methodology, M.C. and C.S.; Software, M.C.,
I.R. and C.S.; Validation, M.C., I.R. and C.S.; Formal analysis, M.C., I.R. and
C.S.; Investigation, M.C.; Writing (original draft preparation), M.C., I.R. and
C.S.; Writing (review and editing), M.C., I.R. and C.S. All authors have read
and agreed to the published version of the manuscript.
FUNDING
This research received no external funding.
INSTITUTIONAL REVIEW BOARD STATEMENT
Ethical review and approval were waived for this study, because the pharmacist
in charge of patient care (M. Condinho) extracted the data from the records, and
as this action has no influence on the previous smoking cessation care process,
Portuguese legislation does not require the submission of this project for
ethics approval.
INFORMED CONSENT STATEMENT
Not applicable.
DATA AVAILABILITY STATEMENT
Not applicable.
ACKNOWLEDGMENTS
The authors are grateful for the participation of smokers who consented to the
use of the information collected during smoking cessation consultations.
CONFLICTS OF INTEREST
The authors declare no conflict of interest.
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Figure 1. Abstinence rate (n = 135).
Table 1. Description of face-to-face consultations and telephone sessions.
Face-to-Face Consultations and Phone ContactsActionDescriptionFirst appointment
(Based on a specific formulary developed for this purpose)-
Smoker’s identification: sociodemographic data (e.g., gender, age, education
level, profession, situation regarding the profession)
-
Smoker’s evaluation: reason for smoking cessation, number of years of tobacco
consumption, number of cigarettes consumed per day, places where he or she
smokes (among other smoking habits), previous attempts, family support, fears
associated with cessation, assessment of dependence, motivation, readiness for
change and anxiety/depression signs and symptoms, among other relevant data
-
Collection of clinical and pharmacotherapeutic information: current health
problems, personal and family history of illness, current medication and
allergies
-
Lifestyle: coffee consumption, alcoholic beverages, exercise, food
-
Determination of anthropometric parameters, blood pressure, carbon monoxide and
spirometry
-
Schedule D-Day
-
Definition of personalized therapeutic care plan
Next appointments
(In general, in the 2nd, 3rd and 6th months)-
Before D-Day
-
Check the implementation of the agreed plan
-
Discuss the difficulties and define strategies to overcome them
-
Highlight the benefits of smoking cessation (5Rs approach) [13,14,15]
-
Reassess motivation and availability to initiate smoking cessation
-
Reassess anthropometric data and blood pressure
-
Schedule D-Day
-
After D-Day
-
Congratulate on success
-
Check for lapses
-
Assess nicotine withdrawal symptoms, major difficulties and adverse reactions to
medication
-
Review lifestyles and strategies to overcome cigarette memory/cravings
-
Evaluate anthropometric data, blood pressure, carbon monoxide
-
Review the therapeutic plan; readjust if necessary
Last appointment
(In the 12th month)-
Congratulate on success
-
Assess nicotine withdrawal symptoms
-
Highlight benefits and address relapse prevention strategies
-
Reassess anthropometric parameters, blood pressure and carbon monoxide levels
Telephone contact-
D-Day
-
Confirm smoking cessation and congratulate
-
Review adherence to the defined therapeutic care plan
-
Evaluate potential adverse reactions
-
Encourage abstinence
-
After D-Day
-
Confirm abstinence and congratulate
-
Evaluate difficulties in the process
-
Evaluate pharmacological therapy, if still present
-
Encourage the smoker to maintain abstinence, emphasizing the benefits
Table 2. Characteristics of the enrolled patients.
FrequencyPercentageAge group 21–393727.440–596044.4≥603828.1Gender
Male7958.5Female5641.5Education <Middle school21.5Middle
school5943.7Secondary4936.3Higher2317NA21.5Work situation
Active10074.1Retired2518.5Unemployed64.4Student32.2NA10.7Motivation for smoking
cessation Weak2518.5Moderate7253.3High2820.7NA107.4Age of tobacco use initiation
9–112014.812–153928.916–205843>201813.3Time spent on tobacco use (years)
7–1096.711–20272021–303324.431–403022.2>403626.7Nicotine dependence
Low2921.5Medium5843High3928.9NA96.7
Note: NA—missing observations.
Table 3. Factors influencing smoking cessation success.
Abstinent
N (%)Non-Abstinent
N (%)Total
N (%)Statistical
SignificanceAge group (years) 21–3920 (54.1)17(45.9)37 (100)χ2 = 8.772,40–5926
(44.1)33 (55.9)59 (100)p = 0.119≥6024 (63.2)14 (2)38 (100) Gender Fisher’s exact
test,Male33 (41.8)46 (58.2)79 (100)p = 0.084Female32 (57.1)24 (42.9)56 (100)
Education <Middle + middle school27 (44.3)34 (55.7)61 (100) Secondary27 (56.3)21
(43.8)48 (100)χ2 = 4.607Higher16 (69.6)7 (30.4)23 (100)p = 0.099Motivation for
cessation Weak12 (48)13 (52)25 (100) Moderate36 (50.7)35 (49.3)61 (100)χ2 =
1.052,High17 (60.7)11 (39.3)28 (100)p = 0.588Nicotine dependence Low16 (55.2)13
(44.8)29 (100) Medium27 (47.4)30 (52.6)57 (100)χ2 = 0.911,High22 (56.4)17
(43.6)39 (100)p = 0.661Pharmacological therapy Fisher’s exact test, Yes68
(58.6)48 (41.4)116 (100)p < 0.001No2 (11.1)16 (88.9)18 (100) No. of
consultations 14 (9.1)40 (90.9)44 (100)χ2 = 59.994, 2–323 (54.8)19 (45.2)42
(100)p < 0.0014–518 (85.7)3 (14.3)21 (100) More than 525 (92.6)2 (7.4)27 (100)
No. of telephone sessions None3 (16.7)15 (83.3)18 (100) 1–229 (47.5)32 (52.5)61
(100)χ2 = 17.845,3–421 (61.8)13 (38.2)34 (100)p < 0.001More than 417 (81.0)4
(19.0)21 (100) Time spent using tobacco (years) 7–106 (66.7)3 (33.3)9 (100)
11–2012 (44.4)15 (55.6)27 (100)χ2 = 12.403, 21–3017 (51.5)16 (48.5)33 (100)p =
0.01331–409 (31.0)20 (69.0)−100 More than 4026 (72.2)10 (27.8)−100 Dyslipidemia
Fisher’s exact test, Yes44 (67.7)21 (32.3)65 (100)p < 0.001No26 (37.7)43
(62.3)69 (100) Anxiety Fisher’s exact test,Yes16 (39.0)25 (61.0)41 (100)p =
0.060No54 (58.1)39 (41.9)93 (100) Depression Fisher’s exact test, Yes6 (27.3)16
(72.7%)22 (100)p = 0.018No64 (57.1)48 (42.9%)112 (100)
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Pharmacy: Determinants of Success from a Real-Life Practice. Pharmacy 2021, 9,
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Condinho M, Ramalhinho I, Sinogas C. Smoking Cessation at the Community
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APA Style
Condinho, M., Ramalhinho, I., & Sinogas, C. (2021). Smoking Cessation at the
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Condinho, M.; Ramalhinho, I.; Sinogas, C. Smoking Cessation at the Community
Pharmacy: Determinants of Success from a Real-Life Practice. Pharmacy 2021, 9,
143. https://doi.org/10.3390/pharmacy9030143
AMA Style
Condinho M, Ramalhinho I, Sinogas C. Smoking Cessation at the Community
Pharmacy: Determinants of Success from a Real-Life Practice. Pharmacy. 2021;
9(3):143. https://doi.org/10.3390/pharmacy9030143
Chicago/Turabian Style
Condinho, Mónica, Isabel Ramalhinho, and Carlos Sinogas. 2021. "Smoking
Cessation at the Community Pharmacy: Determinants of Success from a Real-Life
Practice" Pharmacy 9, no. 3: 143. https://doi.org/10.3390/pharmacy9030143
APA Style
Condinho, M., Ramalhinho, I., & Sinogas, C. (2021). Smoking Cessation at the
Community Pharmacy: Determinants of Success from a Real-Life Practice. Pharmacy,
9(3), 143. https://doi.org/10.3390/pharmacy9030143
Note that from the first issue of 2016, this journal uses article numbers
instead of page numbers. See further details here.
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