Lay Abstract
The Central Valley has one of California’s highest rates of tobacco product use and among the lowest rates of access to traditional primary care providers, making obtaining tobacco cessation treatment challenging. Although the US allows the sale of nicotine replacement therapy (NRT) products over the counter, the use of pharmacotherapy alone, without counseling, does not necessarily help people achieve tobacco abstinence.
In areas where traditional primary care services are less accessible people often obtain care from local pharmacies, which can be visited without an appointment, do not require payment for health advice, and have remained open throughout the COVID-19 pandemic. This combination of characteristics has made them providers of first resort for medically indigent populations that have faced historical exclusion from traditional models of care. Multiple systematic reviews have found that cessation counseling provided by pharmacists in community settings combined with NRT use can double or triple abstinence rates relative to NRT use alone. In 2016 California gave pharmacists the authority to prescribe NRT, and later to submit claims for reimbursement for services as providers, through a process referred to as furnishing. Pharmacist furnishing allows tobacco product users access to higher dosages and additional NRT modalities (e.g., inhalers), as well as to counseling services, that increase the likelihood of successfully quitting. Despite these policy changes, the limited research conducted has found that only a quarter of eligible pharmacists furnish. Barriers identified to furnishing range from concern about the potential reactions of smokers to time constraints.
The overall goal of this proposed research is to decrease tobacco-related disease in California’s Central Valley using pharmacist-led tobacco cessation services. This pilot proposal will leverage a team of researchers studying pharmacist furnishing, researchers and community organizations affiliated with UC Merced’s Nicotine & Cannabis Policy Center (NCPC), and pharmacists providing continuing professional education (California Society of Health-System Pharmacists, CSHP) to identify barriers and facilitators to pharmacist furnishing of NRT in the Central Valley and pilot continuing education based on these findings that can expand tobacco cessation services provided by pharmacists.
