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 Tamara J Brown, 1,2,3 Adam Todd, 1,2,3,4 Claire O’Malley, 1,2,3 Helen J Moore, 1,2,3 Andrew K Husband, 1,2,3 Clare Bambra, 2,3,4 Adetayo Kasim, 3 Falko F Sniehotta, 2,5 Liz Steed, 6 Sarah Smith, 1,2,3 Lucie Nield, 7 Carolyn D Summerbell 1,2,3 To cite: Brown TJ, Todd A, O’Malley C, et al. 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. BMJ Open 2016;6:e009828. doi:10.1136/bmjopen-2015- 009828 ▸ Prepublication history and additional material is available. To view please visit the journal (http://dx.doi.org/ 10.1136/bmjopen-2015- 009828). Received 26 August 2015 Revised 26 November 2015 Accepted 11 January 2016 For numbered affiliations see end of article. Correspondence to Professor Carolyn Summerbell; carolyn.summerbell@durham. ac.uk ABSTRACT 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. 10 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 a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language. Results: 19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 ‘strong’,4 ‘moderate’ and 9 ‘weak’. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost- effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs 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 with 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. Strengths and limitations of this study ▪ To the best of our knowledge, this is the first systematic review that combines evidence from community pharmacy-delivered alcohol, smoking and weight management interventions, and dir- ectly compares these findings with other primary care and community healthcare settings. ▪ This review provides healthcare commissioners with useful evidence on reach, effectiveness and costs when considering using community phar- macies to help deliver smoking cessation and weight management services. ▪ There was insufficient evidence to assess the effectiveness of community pharmacy-based interventions on health equity. ▪ The descriptions available did not allow for the coding of specific aspects of theory and behav- ioural content of the interventions. ▪ Insufficient information was available to examine the relationship between intervention effective- ness and behaviour change strategies and/or models used, implementation factors, or the organisation and delivery of interventions. Brown TJ, et al. BMJ Open 2016;6:e009828. doi:10.1136/bmjopen-2015-009828 1 Open Access Research