Brief Advice Training for Smoking Primary Care

What is Very Brief Advice Opportunistic Advice - in less than 30 seconds – and it works! Can be done in 3 simple steps……

What is Involved with Very Brief Advice The 3 A’s Establish and record smoking status (Ask) Advising on how to stop (Advise) Offering Help (Act)

Ask ‘’How do you feel about your smoking’’ “I see from last time we spoke, you were a smoker, are you still smoking now?” “Do you smoke” “Last time we met, we discussed your smoking, have you had any further thoughts about quitting” Can you think of anymore ways you could ask? Do they smoke? Patients will not resent this question, they expect to be asked this question particularly by a health professional. You can use whatever words feel comfortable, although it is difficult to stop smoking and not everyone wants to stop at that particular time, 70% wish to quit at any time

“Giving up smoking is the best thing for your health” Advise Advise your patient about the benefits of quitting Advise that the best way to stop is with a combination of support and treatment, which can significantly increase the smokers chance of stopping. “Every time you try quitting smoking, you are a step closer to quitting for good” “Giving up smoking is the best thing for your health” “The best way to give up smoking is with a combination of support & treatment. This gives you the best chance of quitting for good”

Act Refer your patient to the Solihull Stop Smoking Service. They are 4x more likely to quit with the service than going it alone. For some smokers it may not be the right time to stop. If so, hand them one of the service cards and advise that if they change their mind to give the service a call. Refer them to the in house service, or the core service, complete a referral form with their consent and we will contact them and invite them into see us. Alternatively give them a clinic list. Or book them in to the in-house stop smoking clinic if you have one. www.ncsct.co.uk/VBA

Act -Examples of what you could say “We hold a weekly stop smoking clinic here on site, would you like me to book you in” “We have a trained stop smoking advisor here at the pharmacy, would you like me to book you in to see them” “You are 4 times more likely to quit with support than going alone, would you like me to refer you to our stop smoking nurse” “We have a specialist stop smoking service, here is their clinic list and a telephone number you can call” You can refer clients directly through to us using the secure email account and we will contact the client directly

Common Questions & Dispelling Myths “Lots of people I know quit smoking and then died” “If I quit smoking, I’ll just get more stressed, what’s the point” “My girlfriends, best-friends, Dad smoked 40 cigars a day and lived until he’s 95, I’m not worried about my smoking” “I’ve just purchased an e-cigarette, I don’t need any extra support” “I’ve already been to your service, I can’t come back again” How would you respond in these situations?

Scenarios Scenario 1: Client attends pharmacy to buy over the counter smoking pharmacotherapy How would you approach this situation? What would you say? Scenario 2: Patient attends the Doctor Surgery Reception to ask for an appointment. You notice they have a packet of cigarettes in their pocket. Is there anything you could say to them?

Other ways of advertising the service Posters in patient waiting rooms Clinic lists, number cards easily accessible Displays for specific events i.e. No smoking day, Stoptober Visual aids i.e. Tar Jar Pictures, images etc. Offering the service on prescriptions Offering the service through text messages Offering the service through campaigns, flu etc. Gets people talking, it’s a starting point for conversation without you initiating the conversation…. Can you think of any other innovative ways to encourage smokers to access support? Is there anything else that would help you in approaching the subject?

80% 90% 30% 90% Visual Aids 90% of foot gangrene cases are of people who smoke, 30% of mouth cancer cases are smokers, 30% of throat cancer cases are smokers, 80% of lung cancer cases are smokers 30%

Clinical Effectiveness of Brief Advice Over half of all continuing smokers will die prematurely from a smoking-related disease. For every two long term quitters, one premature death is avoided (Doll and Peto). 1 Bandolier 2 Gates, Amer Fam Phys 2001 3 West 2006 4 Bandolier 2006 5 Cochrane 2007 6 Anthosen Ann Inter Med 2005 Intervention Outcome NNT Statins Prevent one death over five years 1071 Antihypertensive therapy Prevent one stroke, MI, death over one year 7001 Cervical cancer screening Prevent one death over ten years 11402 GP brief advice to stop smoking < five minutes Prevent one premature death* 803 Add pharmacological support 38-564 Add behavioral support 16-405,6 NNT – numbers needed to treat, you need to treat 107 patients to prevent one death over five years, compared to BA + pharmacotherapy + behavioural support you only need to treat 16-40 patients to prevent one premature death ( for every two long term quitters, one premature death is avoided!

Smoking prevalence http://www.tobaccoprofiles.info/tobacco-control 2013 England 18.4 % West Midlands 17.8 % Solihull 13.0 % Better than U.K average Similar to U.K average Worse than U.K average http://www.tobaccoprofiles.info/tobacco-control (Public Health England Health profile Solihull 2015)

Deaths from Smoking 2013 Adults aged 35 and over Smoking is the leading cause of preventable death and disease in the UK. Smoking related deaths = 79,700, Obesity = 34,100, Alcohol = 6,490, Road traffic accidents 1,713, Illegal drugs 1,605, HIV infection = 504.

Why Go Smoke free After ... Health Benefit ... 72 hours Timeline of health benefits after stopping smoking ... After ... Health Benefit ... 72 hours Breathing becomes easier. Bronchial tubes begin to relax and energy levels increase. 1 month Skin appearance improves, owing to improved skin perfusion. 3-9 months Cough, wheezing, and breathing problems improve and lung function increases by up to 10%. 1 year Risk of a heart attack falls to about half that of a smoker. 10 years Risk of lung cancer falls to about half that of a smoker. 15 years Risk of heart attack falls to the same level that it would be for someone who has never smoked. http://www.patient.co.uk/health/Smoking-The-Facts

Years in Life gained by stopping smoking by age: Age at which stopped smoking Years in life gained 30 40 50 60 10 9 6 3

What can the client expect when accessing a Core Service Clinic One to One Support for smokers on a weekly or fortnightly basis for 12 weeks Carbon Monoxide Reading Access to Nicotine Replacement Therapy Access to Prescription only medication such as Champix and Zyban. Free resources such as leaflets and guides Referral to other lifestyle services if appropriate We work within the NCSCT framework, most clients will not get their chosen medication until the second week of seeing us. This is based on best practice NCSCT guidelines of working.

What Can the Core Stop Smoking Service Offer Evening & weekend drop-ins/appointments Stop Smoking Medication (not available at pharmacy stop smoking services) Home visits Work place Advisor Specialist Service for specific groups including: Pregnant clients Mental Health clients Youths Groups Please give your patient an up to date clinic list; with their permission, you can complete a referral form for the service and we will contact them and invite them in to the service. If you have a patient who requires more structured & timely interventions, again please refer directly to us and we will accommodate them. We can conduct home visits for those that are homebound or recently released from hospital etc. We can provide group interventions for specific groups of patients i.e. mental health, COPD etc. etc. and we have a specialist pregnancy advisor who can conduct home visits

Contacts for the Core Service Gill Whitehead – Administrator 0121 713 8915 Sarah Stables – Service Manager 0121 713 8917 Carrie Illingworth /Jacky Yeomans- North Locality Lead 0121 717 4378 Jake McGee – Primary Care Lead 0121 713 8363 Vicky Masters – Pregnancy Lead 0121 7174374 Cathy Sinton – Workplaces Lead 0121 717 4373 Follow us on Twitter @Solistopsmoking Secure link email:

Any Questions?