TOBACCO and ALCOHOL

EARLY IDENTIFICATION AND BRIEF INTERVENTION

in Primary Health Care

Dagmar SchneidrovDept. of Child and Youth Health

The top 5 risk factors for ill health and premature death, Europe

Source: World Health Organization (2002a). *A disability adjusted life year (DALY) is a measure of one years premature death or ill-health adjusted for the severity of ill-health

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Cost

Cost per year of ill health or premature death prevented

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NNT

Numbers needed to treat (NNT) for one person to benefit

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Maintenance

Action

Relapse

Contemplation

Preparation

Precontemplation

Establishedchange

Stages of Change Model

* Adapted from Prochaska & DiClemente (1986)

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Minimal and Brief Interventions

Opportunity in GPBased on adviceWith or without formal follow upUp to 10 minutesWith self help materials

Usually scheduledBased on motivationWith formal follow upUp to 30 minutesWith self help materials

MINIMAL

BRIEF

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Minimal Interventions(The 5 As method*)

Ask/Assess: whether the person smokes/drinks and the factors that might affect choice of behaviour change, goals and methods. Advise: Give clear, specific, and personalized advice for behaviour change, including information about personal health harms and benefits. Agree: select treatment goals and methods based on the person's readiness to change smoking/drinking behaviourAssist: aid the smoker/drinker in achieving agreed-upon goals by helping them acquire the knowledge, attitudes, skills, confidence, and social and environmental supports for behaviour change Arrange: Schedule follow-up contacts to provide support

*Adapted from Whitlock et al. (2004)

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Basic Components of Brief Interventions

* Adapted from AlcoholCME 2004.

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Communicate Empathy

Instill self-efficacy

Components of Brief Interventions

1. Provide feedback

2. Give advice with permission

3. Assess readiness to change

4. Negotiate goals and strategies

5. Monitor progress

Emphasize patient responsibility

1. Provide feedback Findings on health statusLevel of dependence (Fagerstrm test)

1. Provide feedbackThe health benefits of quitting smokingAfter 20 minutes:Your blood pressure drops to a normal rate for you.The temperature of your hands and feet increases to normal.After 24 hours:Your chance of a heart attack goes down.After 48 hours:Ability to smell and taste begins to improve.After 2 weeks to 3 months:Your circulation improves.Walking gets easier.Your lungs perform up to 30 percent better.

2. Give advice with permissionGive clear, specific, and personalized advice for behaviour change (quit smoking, reduce alcohol consumption)

3. Assess readiness to changeMaking the decision to quitThe decision to quit smoking is one that only you can make. Others may want you to quit, but the real commitment must come from you.Think about why you want to quit.Are you worried that you could get a smoking-related disease?Do you know someone who has had health problems because of their smoking?Do you really believe that the benefits of quitting outweigh the benefits of continuing to smoke?Are you ready to make a serious try at quitting?If you are thinking about quitting, setting a date and deciding on a plan will help move you to the next step.If you are thinking about quitting, setting a date and deciding on a plan will help move you to the next step.

4. Negotiate goals and strategiesSetting a quit date and making a planOn your Quit Day:Do not smoke. This means none at all - not even one puff!Keep active - try walking, exercising, or doing other activities or hobbies.Drink lots of water and juices.Begin using nicotine replacement if that is your choice.Avoid situations where the urge to smoke is strong.Avoid people who are smoking.Reduce or avoid alcohol.Think about how you can change your routine.

4. Negotiate goals and strategiesAvoid temptationStay away from people and places where you are tempted to smoke. Later on you will be able to handle these with more confidence.Change your habitsStaying quitReview your reasons for quitting and think of all the benefits to your health, your finances, and your family.Remind yourself that there is no such thing as just one cigarette -- or even one puff.Ride out the desire to smoke. It will go away, but do not fool yourself into thinking you can have just one.Avoid alcohol. Drinking lowers your chance of success.

5. Monitor progressPropose regular controlsPropose following self-help planPropose attending clinic for cessation smoking or stop-smoking class

ReferenceGual, A., Anderson, P., Segura,L., Colom, J. (2005). Alcohol and Primary Care: Training Programme on Identification and Brief Interventions. Department of Health of the Government of Catalonia: Barcelona. (http://www.phepa.net Resources and publications Training Programme)