Coaching, Motivational Interviewing and Brief Interventions (2) Flashcards
How do brief interventions differ from coaching and motivational interviewing?
Brief Interventions = takes a view that the medical professional know best and they tell you how to do something
Opportunistic
High impact
Talking at the patient, not a conversation
Not specialist, psychological skills
What are the 3 common steos of brief interventions?
Identifies behaviour risk factor
Explains how to best change their high risk behaviour
And
What is MECC?
Make Every Contact Count
Opportunistic approach to behaviour change
Uses the millions of daily interactions in healthcare
Consistent and concise info
Focusing on the most important lifestyle issues
What are the targets of MECC?
x
What is the size of the smoking problem?
Largest preventable cause of premature death
>50% of long-term smokers die prematurely to smoking-related diseases
Why are cigarettes bad for you?
Smoke inhaled is unfiltered as it diffuses straight into the arteriole system - allows every cell in the body to be affected
Cigarettes contain over 4000 chemicals and over 60 carcinogens / metabolic poisons
What diseases does smoking making you more likely to get / exacerbate?
Cataracts Cancer Stroke CVD Peptic ulcers Psoriasis Infertility Erectile dysfunction - suggests small blood vessels are being affected = early signs of CVD
What are the effects of passive smoking? What conditions do they exacerbate?
Exacerbate:
Asthma
Premature births
Malnourished babies
Why do people smoke?
Stress relief Social Cognitive dissonance Confirmation bias Boredom Weightloss Taste Habit
BUT the real reason = nicotine addiction
How addictive is nicotine?
As much or more so than cocaine and heroine?
What questions can you ask to assess addiction level?
How long do you wait until for you first cigarette after you wake up?
Why might asking ‘how many cigarettes do you smoke a day?’ not be appropriate?
Recall bias
Why is ‘cutting down’ smoking not appropriate?
Doesn’t reduce risk proportionately
Only safe level of smoking is no smoking
x
Low cigarette consumption = longer smokes
How should addictive behaviours be treated?
All or nothing
No cutting down
What is the neurophysiology of nicotine addiction?
Most start at 14-15 y/o
Neuroplasticity - the nicotine allows for alpha-4-beta-2 receptors to develop and be activated
These receptors send a signal to the nucleus accumbens (pleasure centre)
Leads to sudden flood of dopamine release = pleasure rush
Once developted, they remain (do not go away)
When the dopamine hit goes away, leads to low mood and craving, leads to negative reinforcement to smoke
What is nicotine addiction / smoking addiction?
Chronic relapsing organic disease in the brain, not a lifestyle choice
What percentage of smokers:
Want to stop?
Succeed?
70% want to stop
30% try each year
Only 3-5% manage through willpower akibe
How cost-effective are smoking cessation interventions?
Very
Estimates cost-effectiveness - costs below £2000 per Life Year Gained
£11,800 spent on statins compared to £2000 for smoking cessation
Smoking cessations signpost to what?
Behavioural support
Pharmacological therapies
x
What do the NHS Stop Smoking Services offer?
x
What is the standard supported quit regime?
Pre-quit appointment
Quit appointment
Follow up appointment
Final appointment?
What are the advantages of a doctor offering the smoking cessation service instead of other medical professionals?
Trust and rapport between patient and doctor already established
Smokers visit their GP more than non-smokers
Independent prescribing = tailored pharmacological interventions for smoking cessation
What are the 3 key things required for long term cessation rates?
x
Number Needed to Treat (NNT) to obtain 1 long term quitter?
Brief Advice alone =
NRT =
Brief Advice alone = 51
NRT = 23
What behaviours do behavioural support groups target?
Reduce motivation to smoke
Commitment to abstain
Enhance x
What is the efficacy of somking cessation?
Most effective
Group
1-2-1
telephone calls
smartphone apps
Least effective
What is NRT?
Nicotine Replacement Therapy
8-12 week treatment, needs to weaned off slowly
9 different forms
Increases smoking cessation rate by 1.58x compared to placebo
Start NRT on quit date
What are the pros and cons of E-cigarettes?
Pros: Does not contain the carcinogens found in tobacco Mimics their behaviour more closely 95% safer than smoking As effective as NRTs
Cons:
Long-term side effects unknown
Many people decide to smoke actual cigarettes alongside e-cigarettes
What to consider for patients using NRTs?
Use enough - avoid under-dosing and irregular use
Long enough - don’t stop early, continue 8-12 weeks to desensitise the receptors
x
What is Bupropion (Zyban)?
What are it’s side effects?
Originally developed to treat depression
Modifies dopamine levels and noradrenergic actvity
Significantly increased smoking cessation rate by 1.94x compared to placebo
Insomnia
Dry mouth
Headache
Nausea
What is Varenicline (Champix)?
Partial nicotine agonist and partial nicotine antagonist
Part blocking - reduces pleasurable effects of smoking
Part stimulating - relieves craving and withdrawal symptoms
Higher abstinence prevalence than bupropion
