Lessons from the Trenches: Implementation of Smoking Cessation Services at an Outpatient Pharmacy in Ontario

Service or Program: Toronto General Hospital Outpatient Pharmacy (TGHOP) Smoking Cessation Program allows patients, staff, families to meet one-on-one with a Certified Smoking Cessation Pharmacist, which includes a readiness assessment, first consultation and seven follow-up counselling sessions over one year.  The pharmacist can facilitate improved access through utilizing a new Ontario policy for Pharmacists Expanded Scope of Practice to prescribe smoking cessation medications.  The program is modelled after the new Ontario Pharmacy Smoking Cessation Program (provincial public plan) and private payer reimbursement program.  Since implementation (May 2014), there have been 32 patients enrolled.  Fourteen patients have already completed the program year, and 9 (64%) have quit.  Pharmacists are greatly involved in either prescribing or recommending prescription smoking cessation medication (92%) for this program.

Justification/Documentation: Patients are provided with a standard of care with structured documentation based on provincial and private payer forms.  Although clients can self-refer, standardized referral forms are available inside the hospital, outpatient clinics, and the pharmacy.

Transferability: Patients and staff can also connect via a QUIT Smoking telephone line, a Smoking Cessation email address, and an automatic referral through online questionnaire.  Innovative advertising through hospital intranet, You tube videos, Stop Smoking week, hospital clinic presentations and Grand Rounds have increased referral rates and raised awareness.  These strategies are easy to implement and highly transferrable.

Impact: This is the first known descriptive report of an outpatient pharmacy experience on smoking cessation services reimbursement for public and private drug plan beneficiaries in Ontario.  Pharmacist- managed smoking cessation program in an outpatient setting promotes inter-professional communication, educates staff about the pharmacist’s expanded scope, and provides seamless transition of smoking cessation after hospital discharge.  It also improves access to smoking cessation for workplace smokers.  This is an example of successful utilization of cognitive services reimbursement in Ontario to improve patients’ outcomes.