A new position statement on treating tobacco dependency in primary care has been published by the International Primary Care Respiratory Group (IPCRG).
The paper reinforces the key messages of the PCRS-UK tobacco dependency campaign which are:
- Smoking is not a lifestyle choice but a relapsing long term condition that usually starts in childhood
- There are effective, evidence based, treatments that can be delivered in primary care
- Diagnosing and treating tobacco dependency is the responsibility of every healthcare professional.
Noel Baxter, PCRS-UK Chair and co –author of the IPCRG statement, says: ‘Health professionals in primary and community care have frequent and important opportunities to identify tobacco use, diagnose dependency and provide advice and treatment to help people to quit. In the UK legislation and effective public health interventions have dramatically reduced tobacco use. Those who continue to smoke are likely to have greater dependency and risk of relapse. Smoking into older age will be associated with acute and long term health problems will have more contact with health services than traditional stop smoking services. The onus sits therefore increasingly within health commissioning and provision.’
The IPCRG paper sets out the following strategies which are quick and easy to implement in the practice:
- Make your practice ‘smoke free’ by banning smoking on the premises, displaying information on smoking cessation in the waiting room
- Offer Very Brief Advice (VBA) to quit. This involves:
- ASK: establish smoking status
- ADVISE: advise on the benefits of cessation and/or making the offer of help to quit
- ACT: act on the patient’s response and make a referral/provide support
- Train practice nurses and other staff to encourage smokers to quit and offer assistance
- Recommend a local telephone counselling service where available, to all smokers who indicate interest in quitting
- Consider prescribing drug treatment for tobacco dependence such as nicotine replacement therapy, bupropion, varenicline
- Use a non-judgemental communication style
- Use motivational interviewing techniques to help people understand their own attitudes to smoking and quitting
The paper also offers guidance on special populations such as people with long term conditions including TB, HIV, cardiovascular disease and respiratory disease; pregnant women, children and adolescents, and people with serious mental illness.
It also describes trends in the use of e-cigarettes, waterpipes and cannabis smoking and offers guidance to primary care clinicians on what to do faced with uncertain evidence.