Health Coaching Flashcards
Describe and explain the smoker’s pathway
70% of people who try to stop using meds and support eventually relapse!
How many VBAs lead to one long term quitter?
51
what is the health coaching framework to tackle alcohol abuse
IBA
- Identification – find out who’s at risk
-
Brief advice- about cutting down
- use Motivation interviewing
- Use Implementation intention (what when how and where)- prompt pt to come up with this
- Support- Self-help or referral to specialised alcohol service (if audit is more than 20)
what screening tool is used for identification for the IBA framework
- How often do you have drink containing alcohol
- How many units of alcohol do you drink on a typical day when you are drinking
- How often have you had 6 or more unit- male (8) on a single occasion in the last year
Apart from AUDIT-C what are the other screening tools for alcohol.
Give the features of this!
SADQ (Severity of Alcohol Dependence Questionnaire)-
- checks severity of dependency.
- used to check whether someone requires assisted alcohol withdrawal and what setting is ideal for it.
CIWA-Ar (Clinical Institute Withdrawal Assessment- Alcohol revised)-
- checks severity of acute, unplanned alcohol withdrawal (lead to death/seizures).
- used in A&E and inpatient wards to assess whether a pt with known dependency is experiencing acute withdrawal.
what are the other screening tools for physical activity and Nutrition
what’s the difference between them!
- Physical activity- GPPAQ (General Practice physical activity questionnaire)
- Nutrition- MUST (Malnutrition Universal Screening tool).
They have varying sensitivity and specificity
what are the demographic differences/inequalities in physical activities
- Men more likely to be active
- Rich people are more likely to be active
- Those with a disability and long-term conditions LESS likely to be active
- Some ethnic groups less likely to be active
What is the framework for Brief intervention for physical activity?
- Ask- ask for permission to discuss it and then screen activity levels using Scot PAS-Q
- Advice
- Assist - SIGNPOST
What is the Scot-PASQ screening tools for physical activity?
where can you signpost pt with physical activity problems
- NHS
- Sports England
- Couch to 5k
- Parkrun
- BBC sport
N.B: People who try to exercise need to be checked up at least yearly (prob 6 months) because there are many barriers to participation in physical activity.
what are the contents of a cigarette?
It has 4k chemicals and 60 known carcinogens and metabolic poisons!
it contains:
- Tar
- Nicotine
- Butane
- Naphthalene
- Ammonia
- Arsenic
What are the reasons people keep smoking?
- Nicotine addiction
- Habit
- Stress
- Weight control
- Social
what is the physiology of smoking addiction
i.e. how does nicotine cause addiction
- Nicotine has the highest binding affinity for alpha 4 beta 2 nicotinic receptors. These receptors are mediators of addiction. This occurs in the VTA of the midbrain.
- Inhaled nicotine reaches these receptors in 7-10 seconds. This then triggers release of dopamine into the nucleus accumbens
- Regular smoking upregulates the a4b2 receptors by 3-4 times. These receptors are long term.
- Smoking is a chronic relapsing organic brain disease; not a lifestyle choice.
what are the keys to stopping smoking effectively?
- Good quality support AND
- Evidence-based treatment- NRT , vareniciline etc
- Wanting to stop- not very successful alone
This improves quit rate up to 4 times greater than any one alone
Explain the features of NHS stop smoking service
They are stop smoking adviser which could be:
- practice nurses
- Hospital nurses
- Healthcare assistants
- pharmacists.
Standard support regime is: 4-6 face to face appointments over 6-12 weeks
What are the advantages of doctors delivering smoking cessation?
- Smokers know, trust and want help to stop from doctor
- Tobacco dependence: a med condition responding to medical treatment
- Doctors are used to tailoring treatment (independent prescribers)
- Cessation advice can be more effective from doctors than counsellors and nurses.
What are the licensed pharmacotherapy for smoking cessation?
- Varenicline- most effective
- NRT : 2nd more effective especially with 2 or more of them
- Bupropion
you should tell the pt that all 3 options are available to be used:
why should 3 of the meds be considered for smoking cessation?
- It allows pt to choose
- If quit attempt fails, they know there are other options
- Different meds work differently for different people
what are the different forms of NRT
- Skin patches
- Inhalator
- Oral spray
- Oral film
- Gum
- Lozenges
- Mini Lozenges
- nasal spray
what is the treatment regimen for NRT?
- The NRT is slowly tapered off
- Treatment lasts 8-12 weeks – use combination therapy
- Spray enters the blood stream quickly
- Use enough for long enough.
What is the pharmacology of buproprion
- Non-nicotinic- used to be antidepressant
- Maintains higher level of dopamine and noradrenergic activity
Therefore has side effects
what is Varenicline pharmacology?
- Partial nicotine agonist
- Partial stimulating: this relieves craving and withdrawal symptoms
- Partial blocking: reduces reward and risk of relapse
what is the realtiy check statistics for 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
Smoking cessation with support is very cost-effective as it has a very low number needed to treat
what are the features of E-cigarettes
- As effective as NRT
- Very popular
- 95% safer than smoking in short term
- Long term impacts not known
- Half of users also smoke
- Controversial and many misconceptions
