Release of New Best Practice Guidelines for Primary Healthcare Providers

August 1st, 2017 by Smokers' Helpline


A recent position statement update published on June 9, 2017 by the International Primary Care Respiratory Group (IPCRG) offers revised best practice treatment guidelines for smoking cessation. This update, which is based on current peer-reviewed research, will be of particular interest to primary health care providers in Newfoundland and Labrador.

According to the IPCRG, many individuals who are “most tobacco dependent” will not be able to quit smoking “without treatment from a health-care professional.” The authors state furthermore that “many people consider their family physician as a key influence and source of advice about smoking.” Primary health care providers are therefore in an excellent position to help patients who smoke start the recovery process and make meaningful, life-long changes.

As a life-saving strategy, helping people quit smoking ranks high when compared to other primary prevention interventions, such as prescribing statins (a group of medications commonly prescribed to treat high cholesterol). This has been demonstrated by research on ‘numbers needed to treat’ to achieve an intervention effect. To prevent a premature death from smoking, a health care provider would have to treat just 46 people with nicotine replacement therapy and behavioural support.

This means that for every 46 people who begin taking nicotine replacement therapy (upon advice from the healthcare provider), 1 person will be saved from premature death linked to smoking. Better still, treating 36 people with bupropion, or just 20 with varenicline, will achieve the same result. By comparison, a health care provider would have to treat 107 individuals with statins to prevent one death over the next 5 years. For antihypertensive treatment for mild hypertension, a health care provider would have to treat 700 individuals to prevent one stroke or heart attack death over 1 year.

Key Evidence-Based IPCRG Recommendations for Treatment
The key smoking cessation-oriented treatment recommendations outlined by the IPCRG include:
• Ensure that your practice is smoke-free. You can do this by: (a) banning smoking everywhere on your clinic/office premises; (b) displaying info about smoking cessation in your waiting room; (c) asking every patient if they smoke; and (d) promoting smoking cessation services.
• Provide patients who smoke with brief advice to quit during their visit and offer assistance with any quit attempt.
• Ensure your team is on the same page; train nurses and other appropriate staff members to encourage smokers to quit and offer assistance.
• Recommend a telephone counseling service/quit line to all patients who are interested in smoking cessation.
• Consider recommending nicotine replacement therapies or prescribing approved smoking cessation medication (i.e. bupropion or varenicline).
• Take a patient-centered approach; tailor your advice or treatment to the individual’s readiness to quit.
• Be non-judgmental when discussing smoking cessation with patients.
• Help your patients understand their own perspectives about smoking and quitting by using motivational interviewing techniques; in doing so, you will empower them to problem-solve autonomously and make their own decisions.
• As needed and where resources are available, provide or arrange for intensive behavioural counseling.

Using Time Effectively

The authors acknowledge that primary health care providers often feel they do not have enough time to address smoking cessation during patient visits, and that some believe brief advice is ineffective. Their research suggests, however, that very brief advice on smoking cessation can in fact be an effective intervention when implemented appropriately.
The IPCRG recommends a three-step process for providing very brief advice to smokers:
• ASK: Ask your patients if they are current smokers.
• ADVISE: Advise your patients that quitting smoking is the best thing they could do for their current and future health.
• ACT: Act on your patients’ responses to advice by either: (a) referring them to cessation services or providing alternative supports; (b) noting in your patient records that advice has been provided if they do not want to quit.

Other Issues
In addition to these revised practice guidelines, the IPCRG’s update also covers current hot-topic issues in smoking cessation research, such as the role that electronic cigarettes (e-cigarettes) might play in future treatment plans. They conclude that while there is some preliminary evidence that suggests e-cigarettes may improve success rates among individuals attempting to quit smoking, only a limited number of these studies are of good quality. More research is needed before health care providers can safely recommend e-cigarettes to patients as a treatment option. They also state that, based on all available evidence at this point in time, patients should be advised that “use of an e-cigarette may impede their chances of quitting smoking at a later date.”

Other issues of note covered in the update include use of carbon monoxide screening for pregnant women, how to approach smoking cessation among waterpipe and cannabis users, as well as gender-specific smoking cessation interventions. We encourage you to click on the link to the article below if these issues are of interest to you.

Learn More
As the first point of contact for many patients who smoke, primary health care providers can undoubtedly make a significant difference in ongoing global efforts to reduce tobacco-related deaths and other health complications. For more information on how the Smokers’ Helpline can help your practice reach out to patients in Newfoundland and Labrador who need assistance with smoking cessation, please call us at 1-800-363-5864 or send an email to shl@nf.lung.ca.

To read the IPCRG’s full position statement update in Primary Care Respiratory Medicine, please click on the following link: https://www.nature.com/articles/s41533-017-0039-5

References:
Van Schayck, O.C.P., Williams, S., Barchilon, V., Baxter, N., Jawad, M., Katsaounou, P.A., Kirenga, B.J., Panaitescu, C., Tsiligianni, K.W.I.G., Zwar, N., Ostrem, A. (2017). Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG. Primary Care Respiratory Medicine, 27(38), 1-12. http://dx.doi.org/10.1038/s41533-017-0039-5