3introduction Aims and outcomes Community pharmacies are now able to supply varenicline for smoking cessation via patient group direction (PGD).Aims and outcomesTo improve access and choice for patients who want to stop smokingTo improve primary care capacity by reducing medical practice workload related to smoking cessation
4When can I supply varenicline? The patient must be suitably willing to quit and willing/able to attend 1-1 sessionsMain contra-indications (refer to PGD for full list):Pregnancy and/or breastfeedingPatient has taken varenicline/bupropion previously in an attempt to stop smokingPatient under the age of 18Patient not willing for information to be passed to GPWhere the patient does not meet criteria for supply under the PGD, they can be signposted to other health and social care professionals
5When should I signpost?If the patient wishes to stop smoking but you cannot supply varenicline under the PGD:Discuss alternative therapies for smoking cessationRefer to Public Health Dorset for further adviceRefer the patient to their GP
6Who can supply under the pgd? ONLY a pharmacist who has carried out the required training can undertake consultations and supply the medication.Technicians are not eligible to supply medicines under PGD.
7CONSIDERATIONSWhen pharmacotherapy is required to assist in supporting a quit attempt patients should be assessed based on medical history, previous use and client choice.NRT or varenicline may be used as a first line option for smoking cessation.Patients should be fully informed of the risks and benefits of the available treatment options through verbal and written information.Note: repeat courses of varenicline are not recommended and are not covered by the PGD.
8The first consultation Complete the relevant stage on PharmOutcomes.Follow the varenicline PGD checklist form, ensuring that all the relevant information is provided to the patient. This information includes:Treatment scheduleAdministrationSide effectsDose taperingConsent to share informationGeneral stop smoking adviceFollow-upWhere to get more information
9The first consultation (continued) Check the patient understands advice given and ask them to sign the consultation form.Keep this form as a record of the consultation and patient consent.Provide the first 2 weeks treatment as a titration pack and arrange the follow up appointment.
10REQUIREMENTS FOR ONGOING CONSULTATIONS Update on PharmOutcomes.Provide a further 2 week supply of varenicline. (Do not supply any more than 2 weeks at any one time).Arrange next follow up appointment.Patients who experience side effects should be advised to seek advice from the pharmacist, or their GP; varenicline is a black triangle medicine (T) and all suspected side effects should be reported to the MHRA on a yellow card.Patients should be advised to discontinue treatment and seek prompt medical advice if they, or their family or carers notice that the patient has developed agitation, depressed mood or suicidal thoughts.
11DOSE AND FREQUENCYThe recommended dose is 1 mg oral varenicline twice daily with a 1 week titration at the beginning and end of the 12 week period.Days 1-3: 0.5mg (white) once dailyDays 4-7: 0.5mg (white) twice dailyDay 8 onwards: 1mg (blue) twice dailyEnd of treatment reduction (starter pack in reverse)1mg (blue) twice daily for 7 days then 0.5mg (white) twice daily for 4 days then 0.5mg daily for 3 daysPatients who cannot tolerate side effects, but are still motivated to continue treatment may have their dose lowered temporarily or permanently to 0.5mg twice dailyProvision for the first two weeks supply is provided as a titration pack, which contains one clear blister of 11 x 0.5 mg film-coated tablets and a second clear blister of 14 x 1 mg film coated tablets.
12Administration and Payment A record of each supply of varenicline must be made on the PMR.The patient’s GP must be notified of the supply of varenicline by fax. It is the responsibility of the pharmacist to inform the patient’s GP.The pharmacy should submit a claim on PharmOutcomes at each stage of supply for payment for supplies of varenicline (part of normal claim).The pharmacy will be paid £6 for each initial supply of varenicline, plus the basic drug cost and £2 dispensing fee for each 2 week supply.
13Contract and pgd sign up sheet If your pharmacy does not yet offer the smoking cessation service, you must ensure that you sign a contract to provide this service and sign a copy of the varenicline PGD sign up sheet. Inform Public Health Dorset of who is trained to provide this service.If your pharmacy already provides the smoking cessation service but you are participating in the supply of varenicline via the community pharmacy PGD you must ensure you sign a copy of the PGD sign up sheet. Inform Public Health Dorset of who is trained to provide this service.
14Varenicline PGD workbook questions NEXT STEPSOnce you have studied the PGD and this workbook please complete and submit the questions and declaration by clicking on the link below:Varenicline PGD workbook questions
15Questions?If you have any questions after reading through this workbook and PGD please contact:Emma WilsonorMichelle Homer