AbstractsPsychology

Nicotine Replacement Therapy (NRT) products are the most commonly used smoking cessation (SC) pharmacotherapy. This study explored the deregulation of NRT products from pharmacy-only distribution to general sales in Finland which took place in 2006. The overall aim of this study was to assess the reasons for the NRT deregulation and its reflections on SC practices in Finland. NRT deregulation was explored from three perspectives: 1) policy-making; 2) community pharmacists as health care professionals providing guidance on NRT use; and 3) NRT users perceptions of NRT in SC. The NRT deregulation from the policy-making perspective was assessed by inductive content analysis of all the publicly available documents and interviews of 12 Members of the Parliament (Study I). A nationwide representative survey to every second pharmacy owner and staff pharmacist (n=2291) was conducted a year after the deregulation in 2006-2007 (Studies II and III). The NRT users perspective was assessed by inductive content analysis of smokers and quitters postings (n=24 481) in five internet discussion areas in the national SC support Forum, STUMPPI, in 2007-2012 (Study IV). The NRT deregulation was politically communicated as a safe and evidence-informed decision promoting public health by advancing SC in Finland (I). However, two of the most important motives for the deregulation, poor NRT availability and the effectiveness of sole NRT use in SC, were largely based on assumptions instead of scientific evidence. At the time of the pharmacists survey, nearly half of the respondents reported being familiar with the Finnish SC Guideline. The familiarity with the Guideline was directly reflected in the level SC actions taken by pharmacist (II). Due to the NRT deregulation, in particular pharmacy owners , motivation towards counselling NRT customers decreased (III). The analysis of smokers and quitters internet-based discussions (IV) revealed that many Finnish smokers and quitters saw NRT as less important in SC or held negative perceptions towards NRT use. From smokers and quitters perspective, the most highlighted factors of successful quitting were quitters own psychological empowerment and peer support from the discussion community. This study found a great variety of NRT usage patterns. Of these, the most commonly emerged one was the use of lower dosage or shorter period compared with the instructions on NRT use. The findings of this study suggest that the sole increased NRT use may not be so crucial for SC as suggested during the political decision-making process. This study provided also evidence that in Finland NRT products are used in a way which may not be optimal for treatment success. Therefore many smokers and quitters could benefit from personalized support for NRT use which would include behavioural components and a plan for NRT use to optimize the treatment. In future it is important to guarantee that community pharmacist are not lost as an important public health resource to provide such individualized NRT…