Helping patients to quit smoking

Primary health professionals play an important role in helping patients to quit by:

• prompting quit attempts
• encouraging people to use support.

A systematic approach works best – following the ‘ABC approach’ for smoking cessation.

ABC approach

1. Ask all patients over 15 years about their smoking status and document this.
2. Provide brief advice to stop smoking to all people who smoke, regardless of their desire or motivation to quit.
3. Make an offer of, and refer to or provide, evidence based cessation treatment.
4. Record that you have given brief advice, if  possible, using a recording form and select the applicable outcomes from the SNOMED CT codes or Read codes.
    

Outcome	SNOMED CT term	SNOMED CT code	Read code
Brief smoking cessation advice given	Brief smoking cessation advice	771155005	@ZPSB.10
Referral to stop smoking support	Referral to stop smoking support	395700008	@ZPSC.10
Prescribed smoking cessation medicine	Smoking cessation medication	713700008	@ZPSC.20
Provided smoking cessation support	Smoking cessation behaviour support	384742004	@ZPSC.30
Refused smoking cessation support	Smoking cessation advice declined	57861000210104	@ZPSC.90

Tools available to assist primary health staff to undertake opportunistic ABC interventions

There are several tools that are available. Districts and PHOs are encouraged to conduct their own research about these products and their specific features. Information can be sourced from providers of the tools as well as other health providers who have implemented these tools. Some examples are listed below.

Prompting tools

Prompting tools remind staff to provide ABC and make referral for cessation support easier. These tools help health professionals with recording their ABC activities by entering the data for them in the PMS database.

Appointment scanner

Appointment scanner identifies the patients among the list of daily appointments who need an updated smoking status and/or offer of cessation support.

Quitline referral tool

With the patient record open in Medtech 32, you can access the Quitline referral by going to the ‘ManageMyHealth’ menu and selecting ‘Launch Quitline Referral’. All Medtech 32 and Medtech Evolution users have access to the ‘ManageMyHealth’ menu which is free and does not require any subscription. In Medtech Evolution, the referral icon can be added to the Quick Access Toolbar.The referral form takes a few seconds to complete. Patient information will pre-populate from Medtech32. This will also automate the smoking cessation Read Codes @ZPSB.10 and @ZPSC.10. An acknowledgement of receipt of referral will be sent in return. You can check the status of your referral by going into ‘Connected Care’ and selecting ‘View Referral Status.

You will receive a referral feedback report into your inbox. This feedback information includes the patient’s contact status and their four week and three month quit status which records automatically for the health targets. Quitline has both the Medtech referral flyer and the referral form available on their website . For those who do not use the Medtech32 Patient Management System, Quitline has a referral form which can be e-mailed or faxed to the details at the bottom of the form.

For more information Quitline website.

Audit tools

Audit tools can retrieve any data on patients and the health interventions they received. For ABC purposes, this means that audit tools can be used for identifying patients whose smoking status were not asked or were missed during attendance at the surgery. An audit tool also helps to identify those who have not attended the general practice in over a year.

Alternative methods to deliver the components of ‘ABC’

Brief intervention has been shown to be most effective when provided by face-to-face contact. However alternative methods can be used to undertake components of ABC to supplement the clinical ‘ABC’ activity that occurs in general practice (see examples below).

It is important to integrate these alternative approaches within routine and ongoing clinical practice. These approaches should also be sustainable, and not only seen as ‘one off’ ways to meet the health target. Examples of methods that can be considered include:

Delivering ‘ABC’ by phone

This method can be used to capture patients who do not attend the practice. If using this method, calls should be made by ABC trained staff (clinical or non-clinical) that have a strong link to the practice, to the GP or Nurse managing these patients. It is important that patients clearly perceive the call as being made on behalf of the GP or the practice. This ensures follow-up. Furthermore, PHOs coordinating this approach are expected to have the permission and involvement of their practices.

Delivering ‘ABC’ by text message and letters

The focus of brief smoking cessation interventions focus on making an offer of support to quit smoking, as opposed to just telling people that they should quit. In line with these healthcare workers should make an offer of support to quit smoking (this should include a brief description of the various options and record the outcome of this offer. There are 4 possible outcomes:

1. Referral to smoking cessation support
2. Prescribed smoking cessation medicine
3. Provided  smoking cessation support eg, done within practice
4. Refused smoking cessation support ie, declined offer of help

Sending letters or text messages cannot be counted as an offer of treatment unless the patient replies and either:

• declines the offer of support or 
• seeks further information or accepts the offer (recorded as brief advice).

All patients who fall into the second category should be followed up and then coded according to the outcome of this follow-up call/visit. Text recipients who reply with an indication of interest in cessation support but who cannot then be contacted should have an entry in their clinical notes for follow up next attendance at the practice.

All outcomes should be coded as listed in the table above.

The effectiveness of alternative methods of contacting patients?

Experience suggests at least 10%-20% of smokers will respond showing interest in cessation support, and a further 10%-20% will indicate that they have stopped smoking since their last contact with the practice.