Pharmacist-led telehealth tobacco cessation services compared with usual care in a community health center.

BACKGROUND: Previous studies regarding tobacco cessation services (TCS) concluded that pharmacist interventions lead to higher or similar quit rates compared with usual care; however, little is known about patient satisfaction with these services. OBJECTIVES: This study assessed 30-day point prevalence abstinence and patient satisfaction of TCS provided by pharmacists compared with primary care providers (PCPs) in a community health center. Secondary objectives assessed the number of encounters and time spent counseling and medications prescribed at each visit. METHODS: Patients at the age of 18 years or older with tobacco use disorder and a new quit attempt were invited to complete a 9-question survey via e-mail, phone, and mail 7 months after their initial tobacco cessation visit. The survey assessed 30-day point prevalence abstinence and patient satisfaction. Chart reviews were conducted to assess time spent counseling and prescribing patterns. RESULTS: The response rate was 38.8% (50/129) overall, 43.9% in the pharmacist group and 36.3% in the PCP group. A 30-day point prevalence abstinence was reached by 22.2% (4/18) in the pharmacist group and 9.4% (3/32) in the PCP group (P = 0.23). Patient satisfaction was significantly higher in the pharmacist group with regard to discussion around medications used to quit smoking (100% vs. 65.6%, P = 0.004), understanding how to properly use the medications (100% vs. 62.5%, P = 0.002), identifying behavioral changes to assist with quitting (94.4% vs. 65.6%, P = 0.036), and frequent follow-up visits (83.3% vs. 46.9%, P = 0.016). Pharmacists spent more time counseling patients and were more likely to prescribe dual nicotine replacement therapy and prescription medications. CONCLUSIONS: There was not a statistically significant difference in abstinence rates, and patient satisfaction with TCS provided by pharmacists and PCPs was high. Pharmacists provide a more intensive service by spending more time counseling patients and providing more follow-ups and are more likely to diversify medications prescribed to quit smoking.

Structural and functional implications of an unusual foraminiferal beta-tubulin.

We have obtained sequence data for beta-tubulin genes from eight species of Foraminifera (forams) and alpha-tubulin sequences from four species, sampling major taxonomic groups from a wide range of environments. Analysis of the beta-tubulin sequences demonstrates that foram beta-tubulins possess the highest degree of divergence of any tubulin gene sequenced to date and represent a novel form of the protein. In contrast, foram alpha-tubulin genes resemble the conventional alpha-tubulins seen in other organisms. Partition homogeneity analysis shows that the foraminiferal beta-tubulin gene has followed an evolutionary path that is distinct from that of all other organisms. Our findings indicate that positive selective pressure occurred on the beta-tubulin subunit in ancestral forams prior to their diversification. The specific substitutions observed have implications for microtubule (MT) assembly dynamics. The regions most strongly affected are implicated in lateral contacts between protofilaments and in taxol binding. We predict that these changes strengthen lateral contacts between adjacent dimers in a manner similar to that induced by taxol binding, thus allowing the formation of the tubulin "helical filaments" observed in forams by electron microscopy. Our results also indicate that substantial changes to these portions of the beta-tubulin molecule can be made without sacrificing essential MT functions.