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LMAP2 > Brief Interventions > Flashcards

Brief Interventions Flashcards

1
Q

What does MECC mean?

A

Make every contact count

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2
Q

What is MECC?

A

Making Every Contact Count (MECC) is an approach to behaviour change that utilises the millions of day to day interactions that organisations and individuals have with other people to support them in making positive changes to their physical and mental health and wellbeing. MECC enables the opportunistic delivery of consistent and concise healthy lifestyle information and enables individuals to engage in conversations about their health at scale across organisations and populations. Focuses on changing the lifestyle factors that can have the most impact

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3
Q

What are the benefits of MECC?

A

Organisational benefits: Can support organisations in meeting their core responsibilities towards their local population health and wellbeing

Community and local health economy benefits; Improve access to healthy lifestyle advice improvement in morbidity and morality risk factors within a local population - cost savings for local health economy

Staff benefits: Competence and confidence to delivery healthy lifestyle messages

National/population benefits: Maximising the benefit from existing resources for improving population health (low to no cost activity)

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4
Q

What is the problem with just telling patients to stop smoking?

A

Negative message
Nothing new
Encourages conflict and denial
Frustrating for both doctor and smoker

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5
Q

What 3 things are needed for a smoker to stop?

A

Wanting to stop smoking: but for 95-97% of smokers, willpower isn’t enough
Good quality support
Evidence based treatments

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6
Q

What are the two main evidence basted treatments for smoking cessation?

A

Varenicline, nicotine replacement therapies

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7
Q

What is VBA?

A

Very Brief Advice

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8
Q

Define Very Brief Advice

A

A simple form 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

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9
Q

What are the three components of VBA?

A

Ask (Establish and record smoking status)
Advise (on how to stop)
Act (offer support and treatment)

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10
Q

What does VBA deliberately avoid?

A

Challenging the addiction

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11
Q

What does VBA not do?

A

Advise smokers to stop
Ask how much or what they smoke
Ask if they want to stop

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12
Q

What questions would you ask if the patient has been recorded as smoking on their last visit?

A

I can see from your last visit you mentioned you smoked, do you still smoke?

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13
Q

What questions would you ask someone that has been recorded as quitting smoking in the last 3 years?

A

It says here you recently quit smoking, how is that going?

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14
Q

Regarding the “ADVISE” element of VBA which of the following is most important?

A

Advising the patient that the best way to stop is with a combination of support and medication

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15
Q

Which one of the following describes what action you would take with your patients who smoke?

A

Deliver VBA at every reasonable opportunity, including to patients with a cancer diagnosis

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16
Q

If a patient is not interested in stopping smoking what should you do?

A

Say that is fine, that help will always be available and to let you know if they change their mind

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17
Q

What are the service options for smokers wanting to quit (3)?

A

Local stop smoking service
In house stop smoking advisor
When no other local support available the GP involved should be involved in the care

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18
Q

What are 5 main benefits of VBA?

A
  • Brief (less than 30 seconds)
  • Records smoking status (as there is a 70% relapse rate)
  • Positive and non-confrontational
  • Opportunistic and Informative
  • Evidence based
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19
Q

How many times does giving VBA result in a long term quitter?

A

On average 51 times

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20
Q

What are the three components of intervention and brief advice?

A
  • Intervention: Who’s at risk from alcohol use
  • Brief Advice: About cutting down
  • Support: Self help or referral to a specialised alcohol service
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21
Q

What audit tool is used to assess alcohol risk?

A

Audit-C

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22
Q

What does an Audit-C score of 1-4 suggest?

A

Low risk (Sensible drinking)

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23
Q

What does an Audit-C score of 5-7?

A

Increasing risk (Hazardous drinking)

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24
Q

What does an Audit-C score of 8-10?

A

Higher risk (harmful drinking)

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25
Q

What does an Audit-C score of 11-12?

A

Potentially Addicted/Dependent

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26
Q

What Audit-C score corresponds to a potentially addicted/dependent patient?

A

11-12

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27
Q

What sorts of questions would you ask in brief advice relating to alcohol?

A
  • Can you think of any ways in which reducing drinking might improve your health?
  • Can you think of any practical steps you could take to reduce your consumption
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28
Q

What are the 4 intervention points that you should try to implement with IBA?

A

What, where, when and how?

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29
Q

Outline the qualities you need to give successful brief advice? (4 points)

A
  • Empathy
  • Non-judgemental
  • Self-efficacy
  • Facilitate patient to make the change
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30
Q

What self-help options could you suggest to your patients?

A
  • Patient information resources
  • Apps
  • Alcohol consumption trackers
31
Q

What 2 main screening tools are used for alcohol usage?

A

Severity for Alcohol dependence questionnaire (SADQ)

The clinical institute withdrawal assessment - alcohol, revised (CIWA-AR)

32
Q

What is the SADQ?

A

• Severity of Alcohol Dependence Questionnaire (SADQ) is recommended by NICE as a way of determining the severity of someone’s alcohol dependence. This can then be used to guide whether someone requires assisted alcohol withdrawal and, if so, which setting is likely to be most appropriate (in the community or an inpatient setting).

33
Q

What is the CIWA-Ar?

A

• The Clinical Institute Withdrawal Assessment – Alcohol, revised (CIWA–Ar) tool is also recommended in order to assess the severity of acute, unplanned alcohol withdrawal, a very serious condition which can result in seizures and death. This tool is often used in Accident and Emergency and on inpatient wards to assess whether a patient with known alcohol dependence is experiencing acute withdrawal and, if so, how severe it is.

34
Q

What are the 2 main screening tools to examine other lifestyle factors?

A

1) • General practice physical activity questionnaire (GPPAQ)
2) • Malnutrition Universal Screening Tool (MUST)

35
Q

Which tool is used to assess the risk of malnutrition in hospital patients?

A

MUST- Malnutrition universal screening tool

36
Q

What is MUST?

A

• Malnutrition Universal Screening Tool (MUST) is commonly used to screen hospital inpatients for risk of malnutrition but can also be used in community settings. Identifying and addressing malnutrition is important for a range of reasons, not least because malnutrition leads to impaired immune function and delayed healing.

37
Q

Physical Activity contributes to morbidity and mortality of a similar magnitude to that of smoking or obesity.

TRUE/FALSE

A

TRUE

38
Q

Brief interventions allow for personalised exercise prescription

TRUE/FALSE

A

FALSE

39
Q

Brief Interventions should be done once and not repeated

TRUE/FALSE

A

FALSE

40
Q

Brief interventions work along a model where permission is asked to introduce the topic, brief advice is given, and the patient signposted or assisted to tools to overcome barriers.

TRUE/FALSE

A

TRUE

41
Q

Brief interventions are part of an approach encompassing individual and societal interventions

A

TRUE

42
Q

What is the scale of problem of physical activity?

A

1 in 4 women and 1 in 5 men are doing less than 30 minutes of physical activity

43
Q

Compare the level of physical activity in males?

A

More physical activity in males

44
Q

Compare the level of physical activity between ethnicity?

A

Most Physical activity in Mixed People and least in Asian (Excluding Chinese)

45
Q

What are the 3A’s method for intervention?

A

Ask, Advice, Assist

46
Q

What is the Scot-PSAQ?

A

The Scottish Physical Activity Screening Questionnaire (Scot-PASQ) provides a framework for meaningful physical activity conversations between health or social care professionals and people in their care. It helps identify how active someone is and informs what physical activity support is needed. It is the second step in the National Physical Activity Pathway.

47
Q

Which screening questionnaire is used to assess physical activity?

A

Scottish Physical Activity Screening Questionnaire (Scot-PSAQ)

48
Q

What is the second step in the national physical active pathway?

A

The Scot-PSAQ

49
Q

What questions are asked in the Scot-PSAQ?

A

In the past week on how many days have you been physically active for a total of 30 minutes or more?

If four days or less have you been physically active for at least two and half hour over course of the past week

Are you interested in being more physically active

50
Q

What was found in the 6 month follow up of a trial where over 4000 inactive patients where randomised to either standard care or physical activity prescription?

A

A 3.9% increase in participants achieving the minimum physical activity requirements

51
Q

Why do people keep smoking?

A
  • Habit
  • Boredom
  • Stress
  • Weight control
  • Taste
  • Mainly: NICOTINE ADDICTION
52
Q

What is the main reason for smoking?

A

Nicotine addiction

53
Q

What types of cancers are associated with smoking?

A 
Oropharynx
Larynx
oesophagus
trachea, bronchus and lung
Acute myeloid leukaemia
Stomach
Liver
Pancreas
Kidney and ureter
Cervix
Bladder
Colorectal
54
Q

Compare the potency of inhaled nicotine to another recreational drug?

A

As or more addictive than heroin or cocaine

55
Q

What are the main mediators of nicotine addiction in the brain?

A

Ventral tegmental area

Nucleus accumbens

56
Q

What are the four main goals of behavioural support in smoking cessation?

A
  • Reduce motivation to smoke
  • Bolster commitment to abstain
  • Enhance ability to cope with cravings
  • Ensure effective use of pharmacotherapy
57
Q

Outline the standard NHS smoking services regime

A

4-6 appointments over 6-12 weeks

58
Q

What are the 4 main advantages of doctor delivered smoking cessation?

A
  • Tobacco dependence – a medical condition corresponding to medical treatment
  • Doctors are independent prescribers, used to tailoring treatment
  • Cessation advice can be more effective from doctors than counsellors and nurses
  • Smokers know, trust and want help to stop from their doctor
59
Q

What are the forms of nicotine replacement therapy?

A

Skin patches
Gums
Inhalators

60
Q

What is buproprion?

A

Originally used to treat depression; modifies dopaminergic and noradrenergic levels – partial dopaminergic/noradrenergic reuptake inhibitor

61
Q

What is the target site for buproprion?

A

Dopaminergic/noradrenergic reuptake inhibitor

62
Q

What is Varenicline?

A

Partial nicotine agonist; part stimulating (Relieves craving and withdrawal symptoms) and part blocking (reduces the pleasurable effects of smoking and potentially the risk of relapse after a temporary lapse – targets α4β2 receptor (A 2015 review noted that stimulation of the α4β2 nicotinic receptor in the brain is responsible for certain improvements in attentional performance; among the nicotinic receptor subtypes, nicotine has the highest binding affinity at the α4β2 receptor (ki=1 nM), which is also the primary biological target that mediates nicotine’s addictive properties)

63
Q

What is the target site for Varenicline?

A

Partial nicotine agonist

alpha4beta 2 receptor

64
Q

What is the therapeutic goal for Varenicline treatment?

A

Relives craving and withdrawal symptoms

65
Q

What is the part blocking effects of Varenicline treatment?

A

Reduces the pleasurable effects of smoking and potentially the risk of relapse after a temporary lapse

66
Q

What is the A4B2 nicotinic receptor responsible for?

A

For certain improvements in attentional performance, among the nicotinic receptors subtypes, nicotine has the highest binding affinity at the alpha-4-beta-2 receptor

67
Q

What are the strengths of E-cigarettes?

A

95% safer than smoking, at least as effective as NRT

68
Q

What are the weaknesses of using E-cigarettes?

A

Long term effects unknown, half of the users also conventionally smoke

69
Q

What is the reality of smoking cessation?

A
  • 20-30% long term quit rate with support and treatment
  • 3-5% long term quit rate with willpower alone
  • 2 or 3 quit attempts with support and treatment for >50% smokers to stop long term
70
Q

What are the 5 main causes of death in the UK?

A 
Ischaemic heart disease
Stroke
COPD
Cancer
Pneumonia
71
Q

What question is better to ask a patient than the number of cigarettes per day to summarise smoking addiction?

A

Time to first cigarette after waking; where waking at night to smoke suggests a high addiction whilst waiting for 2 hours after waking up suggests mild addiction

72
Q

How long does it take nicotine receptors to downregulate?

A

8-12 weeks

73
Q

How would you test smoking cessation?

A

Carbon Monoxide Finger Monitoring

LMAP2 (15 decks)

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