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BACKGROUND: Although smoking is a major public health problem, many clinicians do not routinely provide evidence-based health improvement advice to smokers to help them to quit.
METHODS: Plan, Do, Study, Act (PDSA) cycle methodology was used to design and implement a service development so that health improvement advice for smokers featured in all podiatry consultations provided by a Primary Care Trust in North East England. IT systems were developed to record the number and proportion of patients for whom smoking status was assessed, and the number and proportion of smokers who were given advice to quit and referred for specialist support. A questionnaire to staff explored their perceptions of the development on their clinics and consultations.
RESULTS: During a 6-month period, smoking status was recorded for all 8831 (100%) patients attending podiatry clinics; 83% of smokers were given brief advice to quit; 7% of smokers were given help to access specialist stop smoking support services. Improvements were introduced within existing budgets and did not prolong clinics.
CONCLUSIONS: It is straightforward and inexpensive to develop clinical services so that public health guidance is routinely implemented. More widespread implementation of similar service developments could lead to national improvements in public health
This website provides ‘motivation, education and support for cold turkey nicotine cessation.’
Just to understand the addiction, without losing the patient's attention, respect, or getting them off side.
Maybe instead finding a unique or new angle to educate them with.
Also, if the patient uses the Internet, and wishes to quit, they could investigate this website in their own time.
Joel's "My Cigarette My Friend" has become a staple in cessation programs around the globe and is an excellent ice-breaking article to keep available in your patient waiting area. http://whyquit.com/whyquit/joelcigfriend.html
Motivation
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Nicotine dependent patients who try quitting and fail generally attribute relapse to a lack of strength or willpower. In reality their inability to quit is much more likely due to a lack of understanding of how to quit. WhyQuit.com provides patients the information and understanding needed to successfully quit and stay quit.
Emphasis on cold turkey cessation
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A 2002 JAMA study boldly concluded that "NRT appears no longer effective in increasing long-term successful cessation in California smokers." A March 2003 meta-analysis found that 93% of patients using over-the-counter NRT products relapsed to smoking within six-months.
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All OTC NRT studies conducted to date, a recent "real world" NRT study, and a September 2002 study published in the Journal of the American Medical Association, indicate that the concept of gradual nicotine withdrawal is not an effective means of breaking nicotine's grip upon your life.
Your guidance can prime patients into wanting to quit; our additional information can support them through the nicotine dependency recovery process.
__________________ "I wouldn't give a fig for the simplicity on the near side of complexity; but I would give my right arm for the simplicity on the far side of complexity."
- Oliver Wendell Holmes
Thanks for posting info on such an important public health issue, I am always glad to see smoking cessation included in podiatric practice. However, I should start by saying that I don’t consider some of the information on the website you mention to be credible. As such, I would like to contribute towards the evidence-base posted on this subject thread, in order to further debate on such issues;
here’s a link to NICE public health guidance 10 on smoking cessation services - http://www.nice.org.uk/nicemedia/pdf/PH010guidance.pdf ;
a link to NICE public health intervention guidance no1 on brief interventions and referrals in primary care - http://www.nice.org.uk/nicemedia/pdf..._cessation.pdf ;
finally, a link to a Cochrane systematic review (Stead et al 2008) on NRT effectiveness – http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract
The health professional advice given on the whyquit.com site provides a lengthy review of NRT research, which finally concludes that NRT is not effective. Such conclusions are contrary to the findings of the literature listed above, and in my opinion are a misguided summary of current therapeutic practice. I applaud the questioning of research in this area, in light of the political influence of powerful drug companies involved in NRT manufacture. I don’t think NICE guidelines are written in stone. However, I do feel that the balance of evidence supports the use of NRT for patients attempting to quit. NRT remains one of the first-line drug therapies used by smoking cessation advisors, GPs and pharmacists in primary care settings, as part of a withdrawl-oriented, abstinent-contingent therapeutic approach.
The NHS smoking cessation community has a lot to offer in terms of evidence-base in this area. NRT, and associated drug therapies, are just one area of research as smoking cessation involves health-related behavioural change. Robert West (@UCL) and Peter Hajek (@Barts) develop and run smoking cessation training courses for NHS advisors and are leaders in the UK in this area of research. Should the podiatry community be developing relationships in this area, at the top-end of the profession? Is it already happening?
From a subjective viewpoint, I feel that one of the greatest opportunities for podiatrists is in the assessment of smokers’ level of motivation to quit; the use of motivational interviewing to assess readiness to change detrimental health behaviour is well-practised in other clinical settings, and would arguably increase effectiveness in referral to smoking cessation teams of those patients who are most likely to succeed.
Best wishes, Sim.
I definitely have gained quite a biased opinion in favour of the whyquit website teachings. However, I am always prepared to look at both sides of the coin, so will study these links, when I get a chance.
Elizabeth
__________________ "I wouldn't give a fig for the simplicity on the near side of complexity; but I would give my right arm for the simplicity on the far side of complexity."
- Oliver Wendell Holmes
Elizabeth,
To balance your self-confessed biased opinion, you may also want to study this link, when you get the chance, to take a look at both sides of the coin: http://www.youtube.com/watch?v=Z9O1Cv7wudU
__________________ Science is the antidote to the poison of enthusiasm and superstition
To balance your self-confessed biased opinion, you may also want to study this link, when you get the chance, to take a look at both sides of the coin:
This Youtube video balances nothing.
It has nothing to do with whether we as practitioners can feel confident in recommending one method of nicotine cessation over another.
That is, going cold turkey or using NRT therapy.
The comments underneath the video were, on the other hand of interest.
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NoRegretsForOurYouth (2 days ago) Bill generally was not a healthy guy, and his HEAVY smoking was a leading cause in his tragic death. Smoking is one of the contributing factors to developing pancreatic cancer, multi-pack a day smokers like Bill have 1.7 risk ratio of developing this cancer.
That said, Bill is my favorite comic and i wish we could here what he would have to say about the state of affairs in the world today.
TheNomadicJam (5 days ago) For anyone who thinks bill is pro smoking. Your wrong. He just sees the irony in everything
__________________ "I wouldn't give a fig for the simplicity on the near side of complexity; but I would give my right arm for the simplicity on the far side of complexity."
- Oliver Wendell Holmes
Its called "comedy", never mind. Lighten-up or light-up it's your choice and mine. I'm sure the irony of Bill's situation was not lost on him. Have a nice day.
__________________ Science is the antidote to the poison of enthusiasm and superstition
Maybe enthusiasm is the antidote to the poison of unnecessary mimicry from other posters.
Comedy, yea, I know it, I used to do theatresports, was even up on stage.
One of the points I am trying to make is that the likes of Bill could still be with us, if he had found the right avenue to quit, as something like 80% of smokers truly want to quit, and he was probably one of them.
Anyway, that’s all I have to say on the subject.
__________________ "I wouldn't give a fig for the simplicity on the near side of complexity; but I would give my right arm for the simplicity on the far side of complexity."
- Oliver Wendell Holmes
Podiatry and anti-smoking campaign
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