Brief Interventions 1

Question 1

What are harmful behaviours

Answer 1

Excessive smoking
Excessive drinking
Excessive eating or little physical activity

Case a big health burden individually and socially

Question 2

What is the largest cause of preventable disease and premature death

Answer 2

Smoking

Question 3

How does drinking relate to disease

Answer 3

Implicated in more than 60% of diseases

Question 4

How does physical activity relate to mortality

Answer 4

Physical activity contributes to 1 in 6 deaths

Question 5

What is BI

Answer 5

The term for giving advice to patients to help them change a variety of harmful behaviours

Question 6

What is the purpose of Bi

Answer 6

Doctors don’t have enough time therefore we can give advice opportunistically to promote change with time efficiency

Question 7

What is MECC

Answer 7

When the opportunity arises in a health consultation, we can bring up advice therefore making every contact count

Question 8

How does BI work generally

Answer 8

We identify a risk factor, explain how best to change it and then signpost to the relevant resources to get help

Question 9

What does VBA focus on

Answer 9

Focuses on how to stop a harmful behaviour through a mindful delivery of advice

Question 10

How addictive is smoking

Answer 10

Inhaled tobacco smoke is as or more addictive than heroin or cocaine

Question 11

What are problems with advice to stop

Answer 11

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

Question 12

Do smokers know they should stop?

Answer 12

70% of smokers want to stop - 83% wish they had never started

Question 13

What are the 3 key elements to stopping smoking successfully

Answer 13

Wanting to stop smoking - but willpower is not enough.

Good quality support and evidence based treatments are also needed

Question 14

What is better than advising to stop

Answer 14

Advice on HOW to stop smoking

Question 15

What is VBA for smoking

Answer 15

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

Question 16

What are the 3 parts of VBA, related to smoking

Answer 16

ASK - establish smoking status
ADVISE - The best way to stop is through a combination of support and treatment
ACT - offer support and treatment

Question 17

What does VBA NOT do

Answer 17

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

Question 18

What should you do if patient doesn’t want to quit

Answer 18

Don’t push them to stop, make it clear that the door is always open when they’re ready

Question 19

What are the benefits of VBA

Answer 19

Brief
Records status
Non confrontational 
opportunistic 
Informative
Engaging
Evidence based

Question 20

How many smokers relapse after quitting

Answer 20

70%

Question 21

What is the effectiveness of VBA

Answer 21

Giving 51 VBAs generates 1 long term quitter - therefore less than 30 minutes generates 1 quitter

Question 22

How long should we keep a record of smoking history even if someone has quit smoking

Answer 22

3 years after quit date

Question 23

What is IBA for alcohol

Answer 23

Identification and Brief Advice

Question 24

How many adults drink in Britain

Answer 24

57%

Question 25

Why should we address alcohol use

Answer 25

There’s been a 57% rise in hospital admissions with alcoholic liver disease from 2004/5 - 2016/7

Question 26

What is the general structure of IBA

Answer 26

Identification
Brief advice
Support

Question 27

What do we use to screen alcohol use

Answer 27

AUDIT or AUDIT-c (shorter)

Question 28

What are the score criteria for AUDIT-C

Answer 28

1-4 = sensible drinking - low risk 
5-7 = hazardous drinking - increasing risk
8-10 = harmful drinking - higher risk 
11-12 = potentially addicted or dependent

Question 29

What can we ask when advising about cutting down

Answer 29

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

Question 30

What is implementation intention

Answer 30

What
Where
When
How

This allows to get the specific details about someone’s intentions for change

Question 31

What can we use for supporting cutting down

Answer 31

Self help

• Patient information resources
• Apps
• Alcohol consumption trackers

Referral to alcohol services

Question 32

When do we refer to specialised alcohol services

Answer 32

If there is evidence of dependence; automatic referral by the clinician may lead to greater success

Question 33

What else can we use to assess alcohol consumption

Answer 33

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.

Question 34

What is the CIWA-Ar used for

Answer 34

Clinical Institute Withdrawal Assessment - Alcohol revised

Tool for assessing severity of acute, unplanned alcohol withdrawal as it can cause seizures or death

Question 35

What is the GPPAQ used for

Answer 35

General practice physical activity questionnaire to see how active you are

Question 36

What is the MUST used for

Answer 36

Malnutrition universal assessment tool - inpatient risk of malnutrition as it causes immunosuppression and delayed healing