Avaliação do impacto de serviços farmacêuticos para a cessação do tabagismo.

Abstract

Smoking is recognized as an epidemic chronic disease, which is a risk factor for the development of various types of diseases, and is considered the main preventable cause of illness and early death in the world. Considering that it is less costly to help smokers quit smoking than to treat tobacco-related diseases, smoking cessation is one of the health interventions with the best cost-benefit ratio. Thus, since the 1980s, the Ministry of Health has articulated actions that make up the National Tobacco Control Program. In Belo Horizonte, the initiatives include the role of the pharmacist in the care of smokers. Thus, this study aim to evaluate the implementation and impact of pharmaceutical services aimed at smoking cessation in the city of Belo Horizonte. To this end, a study of the hybrid effectiveness-implementation assay was carried out. To evaluate the implementation of pharmaceutical services for smoking cessation, descriptive analysis of its indicators (from January 2018 to December 2019) was used, retrospectively collected in the Pharmaceutical Assistance Management system. To evaluate effectiveness, the incidence of smoking cessation among individuals enrolled in pharmaceutical smoking cessation services was analyzed. The association between smoking cessation and explanatory variables (gender, use of pharmacotherapy for cessation, degree of nicotine dependence according to the Fagerström test and number of pharmacist visits) was also investigated through univariate and multivariate analyzes performed by Poisson regression, which generated Relative Risk (RR) estimates and 95% confidence interval (IC95%) (significance level = 5%). In the descriptive analysis of the indicators, it was observed that the service is offered in 93 of the 152 units (61.2%), by 65 of the 80 pharmacists (81.3%). A total of 1,761 smoking cessation approaches were performed: 170 individual (9.7%) and 1,591 collective (90.3%). Smoking cessation occurred in 39.4% of individual approaches (n = 67) and 44.8% among collective approaches (n = 712). In the multivariate analysis, the use of nicotine plus bupropion or nortriptyline (RR=1,30; IC95% = 1,08-1,57; p=0,006) and the number of pharmaceutical consultations (RR = 1,21; IC95% = 1,19-1,23; p<0,001) were positively associated with smoking cessation; and the very high degree of dependence was negatively associated (RR = 0,77; IC95% = 0,67-0,89; p = 0,001). The results obtained demonstrate that the promotion of qualified cessation with the pharmacist as the promoting agent was effective in the studied scenario. Considering its potential benefits at the individual and collective level, this study reinforces the need for continued expansion and qualification of the service for monitoring the smoker patient by the pharmacist in Belo Horizonte, which, despite being effectively implemented, still has room for expansion of the offer in the Primary Health Care in Belo Horizonte.