Community pharmacy-delivered interventions for public health priorities : a systematic review of interventions for alcohol reduction, smoking cessation, and weight management, including meta-analysis for smoking cessation

Objectives: To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management. Design: Systematic review and meta-analyses.Ten electronic databases were searched from inception to May 2014. Eligibility criteria for selecting studies: Study design: randomised and non-randomised controlled trials; controlled before-after studies, interrupted times series. Intervention: any relevant intervention set in community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language. Results: 19 studies were included: two alcohol reduction, 12 smoking cessation and five weight management. Study quality rating: six ‘strong’, four ‘moderate’ and nine ‘weak’. Eight studies were conducted in the UK, four in the USA, two in Australia, one each in five other countries. Evidence from two alcohol reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled odds ratio was 2.56 [95% CI 1.45 to 4.53] for active intervention versus usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer-term in a range of primary care and commercial settings compared to control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions. Conclusions: Community pharmacy-delivered interventions are effective for smoking cessation and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness, and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services.