Brief Interventions Flashcards
What does MECC mean?
Make every contact count
What is MECC?
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
What are the benefits of MECC?
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)
What is the problem with just telling patients to stop smoking?
Negative message
Nothing new
Encourages conflict and denial
Frustrating for both doctor and smoker
What 3 things are needed for a smoker to stop?
Wanting to stop smoking: but for 95-97% of smokers, willpower isn’t enough
Good quality support
Evidence based treatments
What are the two main evidence basted treatments for smoking cessation?
Varenicline, nicotine replacement therapies
What is VBA?
Very Brief Advice
Define Very Brief Advice
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
What are the three components of VBA?
Ask (Establish and record smoking status)
Advise (on how to stop)
Act (offer support and treatment)
What does VBA deliberately avoid?
Challenging the addiction
What does VBA not do?
Advise smokers to stop
Ask how much or what they smoke
Ask if they want to stop
What questions would you ask if the patient has been recorded as smoking on their last visit?
I can see from your last visit you mentioned you smoked, do you still smoke?
What questions would you ask someone that has been recorded as quitting smoking in the last 3 years?
It says here you recently quit smoking, how is that going?
Regarding the “ADVISE” element of VBA which of the following is most important?
Advising the patient that the best way to stop is with a combination of support and medication
Which one of the following describes what action you would take with your patients who smoke?
Deliver VBA at every reasonable opportunity, including to patients with a cancer diagnosis
If a patient is not interested in stopping smoking what should you do?
Say that is fine, that help will always be available and to let you know if they change their mind
What are the service options for smokers wanting to quit (3)?
Local stop smoking service
In house stop smoking advisor
When no other local support available the GP involved should be involved in the care
What are 5 main benefits of VBA?
- Brief (less than 30 seconds)
- Records smoking status (as there is a 70% relapse rate)
- Positive and non-confrontational
- Opportunistic and Informative
- Evidence based
How many times does giving VBA result in a long term quitter?
On average 51 times
What are the three components of intervention and brief advice?
- Intervention: Who’s at risk from alcohol use
- Brief Advice: About cutting down
- Support: Self help or referral to a specialised alcohol service
What audit tool is used to assess alcohol risk?
Audit-C
What does an Audit-C score of 1-4 suggest?
Low risk (Sensible drinking)
What does an Audit-C score of 5-7?
Increasing risk (Hazardous drinking)
What does an Audit-C score of 8-10?
Higher risk (harmful drinking)
What does an Audit-C score of 11-12?
Potentially Addicted/Dependent
What Audit-C score corresponds to a potentially addicted/dependent patient?
11-12
What sorts of questions would you ask in brief advice relating to alcohol?
- 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
What are the 4 intervention points that you should try to implement with IBA?
What, where, when and how?
Outline the qualities you need to give successful brief advice? (4 points)
- Empathy
- Non-judgemental
- Self-efficacy
- Facilitate patient to make the change
What self-help options could you suggest to your patients?
- Patient information resources
- Apps
- Alcohol consumption trackers
What 2 main screening tools are used for alcohol usage?
Severity for Alcohol dependence questionnaire (SADQ)
The clinical institute withdrawal assessment - alcohol, revised (CIWA-AR)
What is the SADQ?
• 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).
What is the CIWA-Ar?
• 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.
What are the 2 main screening tools to examine other lifestyle factors?
1) • General practice physical activity questionnaire (GPPAQ)
2) • Malnutrition Universal Screening Tool (MUST)
Which tool is used to assess the risk of malnutrition in hospital patients?
MUST- Malnutrition universal screening tool
What is MUST?
• 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.
Physical Activity contributes to morbidity and mortality of a similar magnitude to that of smoking or obesity.
TRUE/FALSE
TRUE
Brief interventions allow for personalised exercise prescription
TRUE/FALSE
FALSE
Brief Interventions should be done once and not repeated
TRUE/FALSE
FALSE
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
TRUE
Brief interventions are part of an approach encompassing individual and societal interventions
TRUE
What is the scale of problem of physical activity?
1 in 4 women and 1 in 5 men are doing less than 30 minutes of physical activity
Compare the level of physical activity in males?
More physical activity in males
Compare the level of physical activity between ethnicity?
Most Physical activity in Mixed People and least in Asian (Excluding Chinese)
What are the 3A’s method for intervention?
Ask, Advice, Assist
What is the Scot-PSAQ?
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.
Which screening questionnaire is used to assess physical activity?
Scottish Physical Activity Screening Questionnaire (Scot-PSAQ)
What is the second step in the national physical active pathway?
The Scot-PSAQ
What questions are asked in the Scot-PSAQ?
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
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 3.9% increase in participants achieving the minimum physical activity requirements
Why do people keep smoking?
- Habit
- Boredom
- Stress
- Weight control
- Taste
- Mainly: NICOTINE ADDICTION
What is the main reason for smoking?
Nicotine addiction
What types of cancers are associated with smoking?
Oropharynx Larynx oesophagus trachea, bronchus and lung Acute myeloid leukaemia Stomach Liver Pancreas Kidney and ureter Cervix Bladder Colorectal
Compare the potency of inhaled nicotine to another recreational drug?
As or more addictive than heroin or cocaine
What are the main mediators of nicotine addiction in the brain?
Ventral tegmental area
Nucleus accumbens
What are the four main goals of behavioural support in smoking cessation?
- Reduce motivation to smoke
- Bolster commitment to abstain
- Enhance ability to cope with cravings
- Ensure effective use of pharmacotherapy
Outline the standard NHS smoking services regime
4-6 appointments over 6-12 weeks
What are the 4 main advantages of doctor delivered smoking cessation?
- 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
What are the forms of nicotine replacement therapy?
Skin patches
Gums
Inhalators
What is buproprion?
Originally used to treat depression; modifies dopaminergic and noradrenergic levels – partial dopaminergic/noradrenergic reuptake inhibitor
What is the target site for buproprion?
Dopaminergic/noradrenergic reuptake inhibitor
What is Varenicline?
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)
What is the target site for Varenicline?
Partial nicotine agonist
alpha4beta 2 receptor
What is the therapeutic goal for Varenicline treatment?
Relives craving and withdrawal symptoms
What is the part blocking effects of Varenicline treatment?
Reduces the pleasurable effects of smoking and potentially the risk of relapse after a temporary lapse
What is the A4B2 nicotinic receptor responsible for?
For certain improvements in attentional performance, among the nicotinic receptors subtypes, nicotine has the highest binding affinity at the alpha-4-beta-2 receptor
What are the strengths of E-cigarettes?
95% safer than smoking, at least as effective as NRT
What are the weaknesses of using E-cigarettes?
Long term effects unknown, half of the users also conventionally smoke
What is the reality of smoking cessation?
- 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
What are the 5 main causes of death in the UK?
Ischaemic heart disease Stroke COPD Cancer Pneumonia
What question is better to ask a patient than the number of cigarettes per day to summarise smoking addiction?
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
How long does it take nicotine receptors to downregulate?
8-12 weeks
How would you test smoking cessation?
Carbon Monoxide Finger Monitoring
