A pilot study on implementing a pharmacist-led holistic smoking cessation clinic in a psychiatric hospital

BACKGROUND: Smoking prevalence remains disproportionately high among individuals with psychiatric disorders. In Thailand, structured smoking cessation services are rarely embedded within routine psychiatric care. This pilot study describes the development and early evaluation of a pharmacist-led holistic smoking cessation clinic integrated into a tertiary psychiatric hospital in Northeastern Thailand. METHODS: This hospital-based service development project employed a two-phase design. Phase 1 involved stakeholder-informed co-design of the service model. Phase 2 consisted of pilot implementation among psychiatric outpatients with stable mental health status. During the recruitment period, 22 patients were screened and 18 were enrolled (intention-to-treat sample). The intervention combined pharmacologic support-including nicotine gum (2 mg), cytisine (1.5 mg titration over 25 days when clinically appropriate), and Cyanthillium cinereum (formerly Vernonia cinerea) herbal tea-with behavioral counseling and multidisciplinary follow-up over 12 weeks. Primary outcomes included feasibility and acceptability; secondary outcomes assessed preliminary smoking-related and psychological indicators. RESULTS: Of the 18 enrolled participants, 15 completed the 12-week program. Recruitment (81.8%), retention (83.3%), and session adherence (88.9%) exceeded predefined feasibility thresholds. At Week 12, 7-day point prevalence abstinence was 44.4% (8/18, intention-to-treat), and daily cigarette consumption significantly decreased. Patient satisfaction scores were high (mean 4.47/5). No serious adverse events or psychiatric relapses were observed. CONCLUSION: This pilot service demonstrates that a pharmacist-led holistic smoking cessation model can be feasibly integrated into psychiatric care in a provincial Thai hospital. Further controlled studies are warranted to evaluate long-term effectiveness and scalability.