Exploring Patient Perceptions

of Pharmacist-Provided
Tobacco Cessation Services at a
Federally Qualified Health Center
Jacob Zanolla, PharmD
HealthLinc/Purdue University -
PGY-1 Community-Based Pharmacy Resident

Academic Mentor: Karen S. Hudmon, DrPH, RPh

Purdue University College of Pharmacy -
Professor of Pharmacy Practice

We Create Healthy Communities

Conflicts of Interest

The authors have no actual, or potential, conflicts of interests

for this presentation.
Background
Background
 Prevalence of Tobacco Use
Header/subject

Tobacco use is the leading

known preventable
cause of death
in the United States1

In 2021, 18.7% of the adult

population currently used one
or more tobacco products
every day or some days2

1. Leas EC, Trinidad DR, Pierce JP, et al. PLoS One, 2023
2. Cornelius ME, Loretan CG, Jamal A, et al. MMWR Morb Mortal Wkly Rep, 2023
Federally Qualified Health Centers (FQHCs)
Header/subject

Federally funded,
nonprofit health centers
that serve medically
underserved areas and
populations
 Vulnerable and Underserved Populations – Barriers to Care
Header/subject

Lack of
Low health
health
literacy
insurance

Lack of Provider
transport mistrust

Bhatt J, Bathija P. Acad Med, 2018

 Smoking Prevalence in FQHCs
Header/subject

Patients who receive care at Federally

Qualified Health Centers (FQHCs) have
an estimated 67% higher smoking
prevalence than the overall US
population (28.1% vs 16.8%).

Trapl ES, VanFrank B, Kava C, et al. Drug Alcohol Depend, 2021

 Smoking Prevalence in FQHCs
• Patients who report current smoking: FQHC populations
Report severe
Report fair/poor
psychological
health (48.2%)
distress (23.9%)

Have 2 or more Live below 100% of

mental health the Federal Poverty
diagnoses (29.4%) Level (55.5%)

Want to quit
tobacco products
(79.0%)
Trapl ES, VanFrank B, Kava C, et al. Drug Alcohol Depend, 2021
 Why Pharmacy?

• Accessible, extended hours/weekends/holidays

• Cessation medications safe and effective
• Training integrated into pharmacy school curricula
• Comparable efficacy as clinicians in other settings
• Pharmacists in 20 states can now prescribe tobacco
cessation medications

Adams AJ, Hudmon KS (2018); Anthenelli (2016); Hudmon KS, Corelli RL (2018); Carson-Chahhoud KV (2019)
Objective

To apply qualitative methods to characterize patient

perspectives on:
(a) service quality,
(b) appropriateness, and
(c) satisfaction with pharmacy-based tobacco cessation
services within a 12-site FQHC in Indiana
Methods

This study was approved by the

Purdue University
Human Research Protection Program,
protocol 2023-1477.
Description of Pharmacist-Provided
Tobacco Cessation Services

• 15- to 20-minute appointments, led by a pharmacist

• Utilize 5 A’s to gather information and inform prescribing

recommendations
• Ask, Advise, Assess, Assist, Arrange

• Follow-up appointment completed

within 14 days after initial appointment/quit date
Conceptual Framework &
Header/subject
Interview Guide Development

• 20–30-minute semi-structured interviews were completed using an interview guide

• Interview guide development was informed by two theoretical frameworks:

5 Rights of
SERVQUAL
Clinical Decision
Model
Support
Jonkisz A, Karniej P, Krasowska D. Int J Environ Res Public Health, 2021 Sirajuddin AM, Osheroff JA, Sittig DF, et al. J Healthc Inf Manag, 2009
Conceptual Framework &
Header/subject
Interview Guide Development

SERVQUAL Model

Reliability Responsiveness Assurance Tangibles Empathy

Jonkisz A, Karniej P, Krasowska D. Int J Environ Res Public Health, 2021

Conceptual Framework &
Header/subject
Interview Guide Development

5 Rights of Clinical Decision Support (CDS) Model

Right Right Right Right Right

Information Person Format Channel Workflow

Sirajuddin AM, Osheroff JA, Sittig DF, et al. J Healthc Inf Manag, 2009
Sample Questions from Interview Guide

Question from Interview Guide​ Coded Domain​

What moments during your discussion with the pharmacist SERVQUAL:

made you feel particularly supported or understood? Empathy​

How well has the pharmacist responded to your questions or SERVQUAL:

concerns? Responsiveness​

What aspects of the quit smoking program, if any, exceeded 5 Rights of CDS:
your expectations? ​Right Channel​

How did you feel about having the pharmacist prescribe the 5 Rights of CDS:
medication for you, instead of your normal doctor?​ Right Person
Study Population
Header/subject

18 years or
older

Age of Recently completed

English speaking
participant tobacco cessation services
Study Methods – Interview Conduct

Participants recruited at initial or first follow-up

tobacco cessation appointment

Interviews conducted, recorded, and transcribed

Thematic analysis of transcript data

completed by research team
Preliminary Results

• 9 interviews completed; of these, 5 have been analyzed

• Data collection will continue until thematic saturation is achieved
• Common themes identified, thus far:

Preference for shorter,

Appreciation for
telephone-based
frequent follow-up
appointments

Knowledge of
Pharmacists are reliable,
medications/interactions
nonjudgmental tobacco
builds patient's
cessation providers
confidence
Illustrative Quotes

Quote Theme (Coded Domain​)

“Just listening. This is what I want. This is what

worked for me. I like the Chantix, and okay, we’ll do
Listening Skills
that you know? It’s that listening that worked for
(SQ Empathy)
me. Actually, I think it was better than the doctor.”
– Participant 1

“I felt better about it because who knows me

better than the pharmacist as far as the Pharmacist Knowledge and Rapport
medications I am currently taking and what some (5R Right Person)
of my concerns were.” – Participant 2
Illustrative Quotes

Quote Theme (Coded Domain​)

“With my health conditions and the chronic pain, for

me it’s much easier, much less stress to have the
In Person vs Remote
option, you know, to do something over the phone
(5R Right Channel)
instead of having to come in person every time. –
Participant 3

“[The pharmacist] is there and he’s got my back. He’s

really trying to help me. He’s up front with me and
Care for Patient
tells me what he is going to help me do to get to a
(SQ Empathy)
better place with my health.”
– Participant 7
Limitations

• One FQHC, located in the Midwest.

• 100% of study participants are white
76% are at least 45 years of age
• Only 1 out of 9 participants used a tobacco product other
than cigarettes
Next Steps

Apply results to inform

June 2024:
May 2024: refinement of
Complete manuscript
Complete data collection pharmacist-led
and submit for
and analysis tobacco cessation
publication
services
Post-Assessment Question 1

• According to the literature, which of the following correctly

describes a patient population that is more likely to use tobacco
products?

a. People who live in the southern United States

b. People of higher socioeconomic status
c. People with undergraduate college degrees
d. People with mental health diagnoses
Post-Assessment Question 1

• According to the literature, which of the following correctly

describes a patient population that is more likely to use tobacco
products?

a. People who live in the southern United States

b. People of higher socioeconomic status
c. People with undergraduate college degrees
d. People with mental health diagnoses
Post-Assessment Question 2

• Which of the following below is a common barrier that could

prevent a patient from receiving proper assistance with quitting
tobacco?

a. High health literacy and decreased need for provider assistance

b. Decreasing prevalence of smoking cessation providers
c. Lack of access to health insurance and healthcare services
d. Negative public stigma surrounding tobacco cessation services
Post-Assessment Question 2

• Which of the following below is a common barrier that could

prevent a patient from receiving proper assistance with quitting
tobacco?

a. High health literacy and decreased need for provider assistance

b. Decreasing prevalence of smoking cessation providers
c. Lack of access to health insurance and healthcare services
d. Negative public stigma surrounding tobacco cessation services
Acknowledgements

• HealthLinc, Inc.
• Research mentors:
Dr. Nervana Elkhadragy, University of Wyoming School of Pharmacy
Dr. Katy Hilts, Indiana University Fairbanks School of Public Health
Dr. Robin Corelli, UCSF School of Pharmacy
Dr. Karen Hudmon, Purdue University College of Pharmacy
• Purdue Research Project Development Program Series (M. Snyder)
• Funding: APhA and the National Cancer Institute, grant R25 CA 236637
Thank You!

Questions?
Jacob Zanolla, PharmD
HealthLinc/Purdue University -
PGY-1 Community-Based Pharmacy Resident
jzanolla@healthlincchc.org
References
Header/subject
1. Leas EC, Trinidad DR, Pierce JP, et al. Trends in cigarette consumption across the United States, with projections to
2035. PLoS One. 2023;18(3):e0282893. doi:10.1371/journal.pone.0282893
2. Cornelius ME, Loretan CG, Jamal A, et al. Tobacco Product Use Among Adults – United States, 2021. MMWR Morb
Mortal Wkly Rep. 2023;72:475–483. doi:10.15585/mmwr.mm7218a1
3. Bhatt J, Bathija P. Ensuring access to quality health care in vulnerable communities. Acad Med. 2018;93(9):1271-
1275. doi: 10.1097/ACM.0000000000002254
4. Trapl ES, VanFrank B, Kava C, et al. Smoking and cessation behaviors in patients at federally funded health centers -
United States, 2014. Drug Alcohol Depend. 2021;221:108615. doi: 10.1016/j.drugalcdep.2021.108615
5. Adams AJ, Hudmon KS. Pharmacist prescriptive authority for smoking cessation medications in the United States. J
Am Pharm Assoc. 2018;58(3):253-257. doi:10.1016/j.japh.2017.12.015.
6. Jonkisz A, Karniej P, Krasowska D. SERVQUAL Method as an "Old New" Tool for Improving the Quality of Medical
Services: A Literature Review. Int J Environ Res Public Health. 2021;18(20):10758. doi: 10.3390/ijerph182010758
7. Sirajuddin AM, Osheroff JA, Sittig DF, Chuo J, Velasco F, Collins DA. Implementation pearls from anew guidebook on
improving medication use and outcomes with clinical decision support. Effective CDS is essential for addressing
healthcare performance improvement imperatives. JHealthc Inf Manag. 2009;23(4):38-45.
References
Header/subject
1. Leas EC, Trinidad DR, Pierce JP, et al. Trends in cigarette consumption across the United States, with projections to 2035. PLoS One. 2023;18(3):e0282893. doi:
10.1371/journal.pone.0282893
2. Cornelius ME, Loretan CG, Jamal A, et al. Tobacco Product Use Among Adults – United States, 2021. MMWR Morb Mortal Wkly Rep. 2023;72:475–483.
doi:10.15585/mmwr.mm7218a1
3. Bhatt J, Bathija P. Ensuring access to quality health care in vulnerable communities. Acad Med. 2018;93(9):1271-1275. doi: 10.1097/ACM.0000000000002254
4. Trapl ES, VanFrank B, Kava C, et al. Smoking and cessation behaviors in patients at federally funded health centers - United States, 2014. Drug Alcohol Depend.
2021;221:108615. doi: 10.1016/j.drugalcdep.2021.108615
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6. Anthenelli RM, Benowitz NL, West R, St Aubin L, McRae T, Lawrence D, Ascher J, Russ C, Krishen A, Evins AE. Neuropsychiatric safety and efficacy of varenicline,
bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet.
2016 Jun 18;387(10037):2507–2520. PMID: 27116918
7. Hudmon KS, Lahey AM, Czarnik JS, Elkhadragy N, Corelli RL. Tobacco Education in Doctor of Pharmacy Programs in the United States (2021-2022). Am J Pharm
Educ. 2023 Nov;87(11):100120. PMID: 37914465
8. Hilts KE, Corelli RL, Vernon VP, Hudmon KS. Update and recommendations: Pharmacists’ prescriptive authority for tobacco cessation medications in the United
States. J Am Pharm Assoc. Elsevier BV; 2022 Jun 18;62(5):1531–1537. PMCID: PMC9464677
9. Jonkisz A, Karniej P, Krasowska D. SERVQUAL Method as an "Old New" Tool for Improving the Quality of Medical Services: A Literature Review. Int J Environ Res
Public Health. 2021;18(20):10758. doi: 10.3390/ijerph182010758
10. Sirajuddin AM, Osheroff JA, Sittig DF, Chuo J, Velasco F, Collins DA. Implementation pearls from anew guidebook on improving medication use and outcomes with
clinical decision support. Effective CDS is essential for addressing healthcare performance improvement imperatives. JHealthc Inf Manag. 2009;23(4):38-45.