||1R01CA267963-01A1 Interpret this number
||University Of Virginia
||Leveraging Community Pharmacists to Optimize Smoking Cessation Services for Rural Smokers in Appalachia
Rural Appalachian populations have the highest rates of cigarette smoking in the U.S. and are
disproportionately affected by tobacco-related cancers. Publicly available smoking cessation resources (e.g.,
state quitlines, text-based interventions, nicotine replacement therapy [NRT]) are under-utilized by rural
Appalachian smokers. Furthermore, rural Appalachia is medically underserved; thus, smoking cessation
services within primary care settings face additional barriers. Community pharmacists, with their
centralized placement in local communities and clinical expertise, are ideally situated to build capacity
in underserved areas such as rural Appalachia to enhance existing smoking cessation resources for
smokers. Research on pharmacist-delivered smoking cessation interventions is limited and does not provide
for documentation and billing to compensate pharmacists for their time spent counseling patients. Medication
Therapy Management (MTM), a pharmacist-delivered medication adherence approach that allows pharmacists
to receive compensation for providing medication expertise, could be leveraged to promote smoking cessation.
To address this gap, we developed an MTM intervention, QuitAid, to increase smoking cessation among rural
smokers. QuitAid was based on a medication adherence intervention shown to be efficacious in a quitline
setting. The purpose of the proposed study is to use a pragmatic approach, guided by the Reach,
Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to identify the essential
components of an effective smoking cessation program that can easily integrate within community pharmacies
in underserved rural areas. Smokers (n=768) recruited through 14 community pharmacies in rural Appalachia
will be randomized in a 25 full factorial experiment to the following five treatments: (1) QuitAid (Yes vs. No), (2)
tobacco quitline (Yes vs. No), (3) SmokefreeTXT (Yes vs. No), (4) Combination NRT Gum + NRT Patch (vs.
NRT patch alone), and/or (5) 8 weeks of NRT (vs. standard 4 weeks). The primary outcome is biochemically-
confirmed point prevalence abstinence at the 6-month follow-up. We will also assess implementation, including
relative cost, as well as facilitators and barriers of reach, adoption, and maintenance of QuitAid and standard,
evidence-based tobacco treatments through an ask-advise-connect method in community pharmacies. Our
main hypothesis is that a smoking cessation MTM will increase smoking cessation and enhance reach and
adherence to publicly available smoking cessation resources in medically underserved rural areas. The
proposed study will: (1) provide foundational evidence for leveraging community pharmacists in underserved
and rural areas to promote utilization of existing evidence-based tobacco cessation resources through
enhanced MTM support, (2) inform updated national guidance on treating rural smokers, and (3) aid state
legislation efforts related to pharmacy smoking cessation programs and policies. Ultimately, this research will
inform strategies for smoking cessation in rural areas, such that cancer rates achieve parity with urban areas.
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