1. Brief Advice Training for Smoking
Primary Care

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

3. 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)

4. 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

5. “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”

6. 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.

7. 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 account and we will contact the client directly

8. 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?

9. 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?

10. 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?

11. 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%

12. 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 West Bandolier Cochrane 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 patients to prevent one premature death ( for every two long term quitters, one premature death is avoided!

13. 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
(Public Health England Health profile Solihull 2015)

14. 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.

15. 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.

16. 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

17. 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.

18. 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

19. Contacts for the Core Service
Gill Whitehead – Administrator
Sarah Stables – Service Manager
Carrie Illingworth /Jacky Yeomans- North Locality Lead
Jake McGee – Primary Care Lead
Vicky Masters – Pregnancy Lead
Cathy Sinton – Workplaces Lead
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20. Any Questions?