Page 47 - Retail Pharmacy Assistants September 2020

likelihood that a patient later turns to vaping as a quit strategy.
Little and often
The RACGP’s second edition of Supporting Smoking Cessation, a guide for health professionals, lays out the current best-practice guidelines for engaging with patients who are smokers.
Released in December 2019, the
guide shares evidence showing advice from health professionals (including pharmacists3, other allied health staff and smoking cessation specialists) helps those who smoke to quit.
There’s also evidence that when advising smokers to quit, spending
10 minutes or more in doing so results in higher rates of abstinence4 than minimal advice. However, even brief advice given in as little as three minutes is shown to be beneficial.
With the guidelines suggesting that it’s better to give as many patients
as possible brief advice, rather than spending longer with fewer patients, it’s clear the time can’t be wasted.
Recognising this, Quit Victoria developed the ‘Ask, Advise, Help’ model as a structured approach for brief intervention conversations in a wide range of healthcare settings, including pharmacy.
The three-step model offers patients best-practice smoking cessation treatment by linking into multisession behavioural interventions (for example, Quitline) and encouraging the use of pharmacotherapy, as indicated. Three-step approaches for supporting smoking cessation have been used effectively in the UK, Canada and New Zealand.
Brief intervention steps
Ask
The Ask stage of the model is a simple, direct set of questions that establishes smoking history. As up to 76 per cent
of smokers who quit unaided relapse after seven days, it’s important to ask those smokers who have recently quit if they require any help to avoid resuming the habit.
Advise
The Advise stage of the model includes explaining the various tools that can assist smoking cessation, including behavioural intervention (Quitline),
NRT products such as Nicabate and Nicorette, and prescription stop- smoking medications such as varenicline (Champix), available on the PBS.
When advising on NRT products, best- practice guidelines no longer recommend NRT as monotherapy. Instead, RACGP guidelines say combination NRT has
SMOKING CESSATION 45 been found to be more effective and is
the preferred approach, particularly when accompanied by behavioural support.
Alexandra Daskal, Healthcare Professional Manager Self-Care at Johnson & Johnson, manufacturer of the Nicorette range of NRT products, explains how combination NRT supports firm adherence to smoking cessation treatment.
“The nicotine patch ensures stable baseline nicotine levels, while smokers are empowered to deal with acute cravings and withdrawal symptoms through self-administering of immediate- release NRT,” she said.
The initial selection of pharmacotherapy products is an important process, closely linked to quitting adherence and the quality of patient outcomes.
Ms Dean said: “When the initial pharmacotherapy decision around the dose, products and combination isn’t right, we’re probably not going to get the biggest bang for the NRT buck.
“Looking at pharmacists, they’re the best placed, probably of all clinicians, to be able to maximise that decision. When they look at what they’re going to use as a clinician, they understand clinical suitability and things like adverse effects, and it’s that in-depth understanding of medicines that
puts pharmacists at the forefront in supporting smoking cessation.”
Help
In the Help step of the model, the best- practice recommendation is to implement some of the steps there and then, while with the patient.
“Best-practice care could be getting a script from the patient’s GP for something that’s PBS subsidised and not going to be a massive cost to the individual,” Ms Dean said.
“Also, instead of giving the patient the number for Quitline, ask the patient’s permission, then take the 30 seconds
to call Quitline and make the referral on their behalf. When you do the referral for a patient yourself, instead of just giving them a piece of paper with the number, there’s a significant difference in the patient uptake.”
References
1. doi.org/10.1080/08958378.2020.1776801
2. advances.sciencemag.org/content/advances/6/22/ eaaz0108.full.pdf
3. ‘Community pharmacy-delivered interventions for public health priorities’. BMJ Open, 2016; 6: e009828. 4. ‘Clinical practice: Treating smokers in the healthcare setting’. N Engl J Med, 2011; 365 (13): 1222–31.
THE NRT TOOLS
Nicotine patch: Discreet, once-a-day, slow-release product aimed at beating cravings and withdrawal symptoms for up to 16 or 24 hours. Available in different strengths.
• Ideal for those who want to quit immediately.
• The primary source of relief as part of combination NRT.
Gum: Actively fights cravings and withdrawal symptoms.
• Absorbed quickly through the lining of the mouth, helping to relieve
cravings effectively.
• Chewing can help with other withdrawal symptoms, such as stress and anxiety.
Spray: Fastest craving relief.
• Fast and convenient for breakthrough cravings or situations needing
quick relief.
• Begins to relieve cravings from 30 seconds.
Lozenge: Calms cravings even after the lozenge is gone
• Ideal for smokers who want flexible but discreet craving control. • Different strengths and flavours.
Inhalator: Keeps hands busy by replacing the hand-to-mouth action of smoking.
• Releases nicotine to help relieve cigarette cravings and nicotine
withdrawal symptoms.
• Nicotine is absorbed through the mouth and throat.
RETAIL PHARMACY ASSISTANTS • SEP 2020