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RespiratoryMar 8, 2022

Physio Rachael Moses urges clinicians to 'make every contact count' in bid to stub out smoking

Leading respiratory physiotherapist Rachael Moses has urged clinicians to ‘make every contact count’ by encouraging patients to take the necessary steps to quit smoking.

Speaking exclusively to PhysioUpdate on No Smoking Day 2022 (9 March), Ms Moses, a consultant physiotherapist and president of the British Thoracic Society (BTS), said: ‘Making every contact count as clinicians is so important to ensure we take the opportunity to discuss smoking habits and behaviours and [make] the offer of referral to tobacco dependency teams.

‘The most successful interventions for smoking cessation are based on personalised care approaches and shared decision making.’

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Breath of fresh air: the BTS offers clinicians help on running tobacco dependence services

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Ms Moses continued: ‘We know that tobacco dependency is a condition that needs dedicated, holistic evidenced based interventions. There are many elements of these interventions – including information and advice, behavioural therapy, pharmacology and peer support.’

Making every contact count as clinicians is so important to ensure we take the opportunity to discuss smoking habits and behaviours and [make] the offer of referral to tobacco dependency teams [Rachael Moses]

What the BTS offers

In a bid to help clinicians to plan and deliver a comprehensive service, the BTS has developed a Respiratory Futures website, which features practical step-by-step guides, good practice examples and educational materials. The society, which has more than 4,000 members, has also published a ‘tobacco dependency roadmap’ – a seven-step guide to setting up a tobacco dependence treatment service.

Less than half of hospital patients who smoke get advice

To coincide with this year’s No Smoking Day, the BTS released preliminary results of an audit of tobacco dependency treatment services in UK hospitals. The audit is based on more than 14,000 patient records from 120 UK hospitals in 2021. It revealed that less than half (45 per cent) of smokers in hospitals received very brief advice (VBA) – in which healthcare practitioners ask patients if they smoke, give advice on how to stop and offer appropriate help.

The revelation that VBA is only being offered to a minority of smokers suggests that the NHS is missing a ‘golden opportunity’ to help smokers beat their tobacco addiction, the BTS said.

Training gap

Clinicians at all levels should be able to provide VBA at any point during a patient’s hospital journey to capitalise on the effectiveness of this intervention. However, the audit showed that only half of NHS trusts were offering frontline healthcare staff regular smoking cessation training, the BTS said.

The audit also found that pharmacotherapy (nicotine replacement therapy and addiction-breaking drugs) was only offered to a third of patients who smoked (33 per cent). On a more positive note, however, the BTS said that the percentage of smokers among adult inpatients appeared to have fallen from 24 in 2019 to 21 per cent in 2021.

'Considerable opportunity'

Professor Sanjay Agrawal, England’s national specialty adviser for tobacco addiction, said the BTS audit findings highlighted the 'considerable opportunity to screen and treat tobacco dependency across the NHS'.

Professor Agrawal added: ‘The NHS Long Term Plan is committing significant resource to put in place tobacco dependency treatment services across hospitals, maternity and community mental health services by 2023-24, that will lead to the systematic identification and treatment of tobacco dependency. We look forward to working with BTS and other partners on this programme of work to improve lung health and reduce health inequalities.’

Focus needed from 'frontline organisations'

Paul Walker, BTS chair, said: ‘Tackling tobacco dependence is fundamental to respiratory medicine and all respiratory professionals need to make every contact count, using that opportunity to offer advice and help to aid smokers to quit.'

Dr Walker added: ‘As we begin to recover services post-Covid, we need to ensure that all hospitalised smokers are offered advice and pharmacotherapy, rather than the minority who currently receive this. This requires a focus from frontline healthcare organisations on smoking cessation training which is essential to deliver this intervention.'

The full audit report will be published later this spring. It will include more data on the availability and prescription rates of pharmacotherapy and other NICE-recommended interventions to quit smoking, as well as examining the availability of tobacco dependency treatment services.

For more information on VBA’s effectiveness, see: Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction, 107 (6), 2012. Visit: https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03770.x

To find out more about the BTS programme on running or setting-up tobacco dependence treatment services, visit: https://www.respiratoryfutures.org.uk/programmes/tobacco-dependency-project/

A toolkit for professionals is also available on the Today is the Day website. See: https://www.todayistheday.co.uk

Author: Ian A McMillan
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