Brief Interventions 1 Flashcards
What are harmful behaviours
Excessive smoking
Excessive drinking
Excessive eating or little physical activity
Case a big health burden individually and socially
What is the largest cause of preventable disease and premature death
Smoking
How does drinking relate to disease
Implicated in more than 60% of diseases
How does physical activity relate to mortality
Physical activity contributes to 1 in 6 deaths
What is BI
The term for giving advice to patients to help them change a variety of harmful behaviours
What is the purpose of Bi
Doctors don’t have enough time therefore we can give advice opportunistically to promote change with time efficiency
What is MECC
When the opportunity arises in a health consultation, we can bring up advice therefore making every contact count
How does BI work generally
We identify a risk factor, explain how best to change it and then signpost to the relevant resources to get help
What does VBA focus on
Focuses on how to stop a harmful behaviour through a mindful delivery of advice
How addictive is smoking
Inhaled tobacco smoke is as or more addictive than heroin or cocaine
What are problems with advice to stop
Negative message that nags the patient as they have already heard it before - it can bring up conflict and denial in the smoker and thus is a long frustrating process
Do smokers know they should stop?
70% of smokers want to stop - 83% wish they had never started
What are the 3 key elements to stopping smoking successfully
Wanting to stop smoking - but willpower is not enough.
Good quality support and evidence based treatments are also needed
What is better than advising to stop
Advice on HOW to stop smoking
What is VBA for smoking
A simple from of advice designed for busy clinicians to be used opportunistically in less than 30 seconds in almost any consultation with a smoker by telling them how to stop and directing them appropriately
What are the 3 parts of VBA, related to smoking
ASK - establish smoking status
ADVISE - The best way to stop is through a combination of support and treatment
ACT - offer support and treatment
What does VBA NOT do
It doesn’t challenge the addiction therefore doesn’t advise smokers to stop, ask how much they smoke, or ask if they would like to stop
What should you do if patient doesn’t want to quit
Don’t push them to stop, make it clear that the door is always open when they’re ready
What are the benefits of VBA
Brief Records status Non confrontational opportunistic Informative Engaging Evidence based
How many smokers relapse after quitting
70%
What is the effectiveness of VBA
Giving 51 VBAs generates 1 long term quitter - therefore less than 30 minutes generates 1 quitter
How long should we keep a record of smoking history even if someone has quit smoking
3 years after quit date
What is IBA for alcohol
Identification and Brief Advice
How many adults drink in Britain
57%
Why should we address alcohol use
There’s been a 57% rise in hospital admissions with alcoholic liver disease from 2004/5 - 2016/7
What is the general structure of IBA
Identification
Brief advice
Support
What do we use to screen alcohol use
AUDIT or AUDIT-c (shorter)
What are the score criteria for AUDIT-C
1-4 = sensible drinking - low risk 5-7 = hazardous drinking - increasing risk 8-10 = harmful drinking - higher risk 11-12 = potentially addicted or dependent
What can we ask when advising about cutting down
Can you think about any ways in which reducing your drinking might improve your health?
Can you think of any practical steps you could take to reduce your consumption
What is implementation intention
What
Where
When
How
This allows to get the specific details about someone’s intentions for change
What can we use for supporting cutting down
Self help
- Patient information resources
- Apps
- Alcohol consumption trackers
Referral to alcohol services
When do we refer to specialised alcohol services
If there is evidence of dependence; automatic referral by the clinician may lead to greater success
What else can we use to assess alcohol consumption
Severity of Alcohol Dependence Questionnaire (SADQ) used by NICE - used to see if someone needs assisted alcohol withdrawal and the most appropriate setting for this ie community or in patient.
What is the CIWA-Ar used for
Clinical Institute Withdrawal Assessment - Alcohol revised
Tool for assessing severity of acute, unplanned alcohol withdrawal as it can cause seizures or death
What is the GPPAQ used for
General practice physical activity questionnaire to see how active you are
What is the MUST used for
Malnutrition universal assessment tool - inpatient risk of malnutrition as it causes immunosuppression and delayed healing
