Every contact 'vital' in tobacco addiction, say Rachael Moses, Ema Swingwood and Rachael Colclough
A trio of leading respiratory physiotherapists has responded to evidence suggesting that healthcare professionals are missing opportunities to reach out and offer support to hospital patients who smoke.
The evidence that too little is being done came in a report – titled National Smoking Cessation Audit 2021 – that was released earlier this month by the British Thoracic Society (BTS). The BTS, which conducted a UK-wide audit involving 120 acute hospitals and more than 14,000 patient records, raised concerns that the NHS was apparently falling to fulfil its commitment to help all hospitalised patients who smoke to quit by 2023-2024.
Society president Rachael Moses exclusively told PhysioUpdate: ‘The concept of “making every contact count” couldn’t be more useful than when we interact with patients with tobacco addition.'
Offering support is 'vital'
As therapists we often have conversations with our patients about behaviour and lifestyles to support their self-management and offering support for their tobacco addiction is a vital aspect of this [Rachael Moses]
Ms Moses, who is also a prominent consultant respiratory physiotherapist, said: ‘As therapists we often have conversations with our patients about behaviour and lifestyles to support their self-management and offering support for their tobacco addiction is a vital aspect of this.’
While acknowledging that the BTS audit found that some ‘modest improvements’ had occurred since it conducted similar audits in 2016 and 2019, Ms Moses pointed out that the evidence demonstrated that more efforts had to made to support in people in hospitals with ‘tobacco addiction’.
Ema Swingwood and Rachael Colclough's comment
Ema Swingwood and Rachael Colclough argued that physiotherapists have the potential to have a greater impact on this issue. Ms Swingwood is a Bristol-based respiratory physiotherapist who sits on the BTS’s education and training committee, while Ms Colclough is a Birmingham-based respiratory physiotherapist who chairs the Association of Chartered Physiotherapists in Respiratory Care.
They told PhysioUpdate: ‘The BTS National Audit Report on smoking cessation highlights that we still have important work to do. Physiotherapists are extremely well placed to contribute to this important work and already do so.
‘As physiotherapists we work in a range of care settings – the community and GP practices through to acute hospitals, across a spectrum of clinical specialties. This enables us to link with patients at different time points of their care both in and outside of a respiratory setting, rather than limiting such important conversations to a GP practice or when a patient is in hospital acutely unwell.'
Scope for improvement
Strong clinician-patient relationships often develop during pulmonary rehabilitation programmes and could offer opportunities to introduce health promotion and behaviour change components in a collaborative way, the pair suggested.
‘Though physiotherapists are educated about smoking cessation at undergraduate level, enabling them to complete the important ‘Very Brief Advice’ conversation, they have, in many cases, the skills to do more,' Ms Swingwood and Ms Colclough added. ‘In addition, a growing number of physiotherapists have completed additional training to become independent prescribers.'
What did the 2021 BTS audit find?
The recording of patients’ smoking status remained below target – with 79 per cent of people admitted to hospital having had their smoking status recorded (compared to a figure of 77 per cent logged in 2019)
Of the people that were identified as smokers
- less than half (45 per cent) were provided very brief advice (VBA) to quit.
- four in 10 (40 per cent) were offered a referral to a tobacco dependency service (down from 44 per cent in 2019)
- about one in 10 (9 per cent) were seen by a tobacco dependency practitioner while in hospital
- one in 20 (5 per cent) were provided with the most effective interventions recommended by the National Institute for Health and Care Excellence (nicotine replacement therapy, varenicline – a medicine that reduces cigarette cravings – and vaping)
On the plus side, the number of smokers admitted to hospital declined slightly (21 per cent of acute patients smoked in 2021 compared to 24 per cent in 2019). About one in seven (15 per cent) of patients who smoked were referred to a hospital or community-based smoking cessation service, compared to about one in eight (12 per cent) in 2019 and one in 12 (8 per cent) in 2016
The trio of PhysioUpdate contributors urged colleagues to investigate the ‘incredible resources’ that are freely available on the BTS’s respiratory futures site. For more information, visit: https://www.respiratoryfutures.org.uk/programmes/tobacco-dependency-project
For more information on the BTS audit, visit: https://www.brit-thoracic.org.uk/news/2022/bts-audit-of-hospital-based-tobacco-dependency-treatment-services-finds-modest-improvement-since-2019/
To find out more about the British Thoracic Society, visit: https://www.brit-thoracic.org.uk
To find out more about Rachael Moses' role, visit: https://www.physioupdate.co.uk/news/rachael-moses-makes-history-as-the-first-physio-to-be-president-of-the-british-thoracic-society
To find out more about the Association of Chartered Physiotherapists in Respiratory Care, visit: https://www.acprc.org.ukAuthor: Ian A McMillan