Contacting patients to offer brief advice to quit smoking

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Why is there a tobacco health target for primary care?

The intention of this health target is to provide better help for people who smoke to quit.

Primary health care professionals play an important role in prompting quit attempts and encouraging people to use support that will increase a person’s chances of successfully quitting.

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How is this best achieved?

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

  1. Ask about and document smoking status for all patients 15 years and older.

  2. For all people who smoke, advise them to stop and offer cessation support.

    1. This can be done in 30 seconds.

    2. Offering cessation support (e.g. a referral to a smoking cessation provider or a prescription for a smoking cessation medicine with advice on how to obtain cessation support) will prompt more people to make a quit attempt than just advising them to quit.

  3. Make a strong recommendation to use support in addition to medication and be enthusiastic about the advantages.

  4. Record that you have given brief advice, if possible using a recording form, otherwise use one of the following codes.

    • Brief smoking cess adv given (@ZPSB.10)
    • Ref to smoking cess support (@ZPSB.10)
    • Prescribed smoking cess medication (@ZPSB.20)
    • Smoking cess behaviour support (@ZPSB.30)
    • Refused smoking cess support (@ZPSB.90)

What happens when a patient refuses an offer of cessation support?

This should be documented. The documentation of ‘refused offer of cessation support’ implies that a discussion around stopping smoking has occurred and an offer of support to quit were made. This will still count towards the health target.

What tools are available to assist primary care staff to undertake opportunistic ABC interventions?

There are a number of tools that are available. DHBs 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 assist health professionals with recording their ABC activities by entering the data for them in the PMS data base.

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 users have access to the ‘ManageMyHealth’ menu which is free and does not require any subscription. 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 (below link). 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, go to the 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.

Can alternative methods be used to deliver the components of ‘ABC’?

Yes. 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 telephone

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, in particular 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 facilitates and 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 New Zealand Guidelines for helping people to stop smoking was updated in 2014. The focus of brief smoking cessation interventions now focus on making an offer of support to quit smoking, as opposed to just advising 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 four possible outcomes:

  1. Referral to smoking cessation support @ZPSC.10
  2. Prescribed smoking cessation medicine @ZPSC.20
  3. Provided smoking cessation support e.g. done within practice @ZPSC.30
  4. Refused smoking cessation support i.e. declined offer of help @ZPSC.90.

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

  • declines the offer of support (code as @ZPSC.90) or 
  • seeks further information or accepts the offer (code as @ZPSB.10 - 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.

How effective are alternative methods of contacting patients?

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

More information

If you are unsure whether any initiative within primary care that you are proposing meets the health target requirements, or have any further questions, please contact the tobacco control team at the Ministry of Health: tobacco@moh.govt.nz

We are currently working on an information sheet covering all different IT tools available to PHOs and practices that can be used to improve recording and reporting of the Health Target results. For further clarification around the health target regarding delivery, coding and reporting of the ABC activities, please read the Guidance for the Tobacco Primary Care Health Target.

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