the health care provider’s role in tobacco...

February 4, 2015

The Health Care Provider’s role in Tobacco Cessation in BC

Agenda Stats on Smoking Rates Benefits of Quitting Asking About Tobacco Use What is QuitNow? BC Smoking Cessation Program Nicotine Replacement Therapy E-Cigarettes

Purpose:

To increase nurses’ confidence, commitment and capacity for delivering tobacco cessation interventions.

Stats on Smoking Rates

Smoking in British Columbia

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

2009 2010 2011 2012 2013

Number of Smokers in BC

British Columbia

Males

Females

645,000 (16.2% of 12 years & older)

BC Current Smoking (daily or occasional) % of Population # of People

Interior HA 18% 114,341 East Kootenay 20% 14,348 Kootenay-Boundary 17% 11,835 Okanagan 16% 47,611 Thompson/Cariboo 22% 40,546

Fraser HA 13% 195,398 Vancouver Coastal HA 16% 160,248 Vancouver Island HA 18% 116,954 Northern HA 25% 57,650 Note: HSDA-level data should be used with caution

Statistics Canada: Canadian Community Health Survey, 2013

Prevalence of Smoking by Age, British Columbia, 2013

16.2 7.3 21 20.5 17.5 9.2

Statistics Canada: Canadian Community Health Survey, 2013

Helping a smoker quit is the single most powerful

preventive intervention in

clinical practice.

Woolf, S. (1999). JAMA. 282(24):2358-2365

Consequences of Tobacco Use 1 out of every 2 smokers will die prematurely due to

tobacco related illness (almost half of these have a mental health condition).

Doll, R., Peto, R., Wheatley, K., Gray, R., Sutherland, I. (1994) BMJ 309(6959)

Quit Quiz How many smokers are considering quitting within the next 12 months? A. 10% B. 30% C. 70% D. 85%

Who Wants to Quit?

70% of smokers are considering quitting

in the next 12 months

*2008 TABS Report (April 2009)

Effect of interventions

Asking About Tobacco Use

You ASK about their tobacco use You ADVISE them to Quit

You refer them to QuitNow and we do the rest:

ASSESS for willingness to quit ASSIST in a quit attempt ARRANGE for follow-up

USDHHS Guidelines – 2008 Update

Ask – Why?

• Tobacco use is the most important modifiable risk factor for heart disease, lung disease and cancer.

• It is our responsibility to have this information when we are caring for our patients.

• A change in tobacco status can cause significant drug interactions.

• Because you can help.

Ask – Have you used any tobacco products in the past

month?

And then…document.

Admission History, page one

Advise – How?

CLEAR STRONG

PERSONALIZED NON-JUDGEMENTAL

Even very brief advice from a health care provider can have a powerful effect

Referrals from Jan to Sept 2014 in Interior Health

Number of faxes sent Physician fax was received from City 29 Kelowna General Hospital Kelowna 14 Kootenay Boundary Hospital Trail 10 Kootenay Lake Hospital Nelson 9 Associate Medical Clinic Cranbrook 9 The Centreville Clinic Vernon 8 Dr. James Noiles Nelson 8 The Smile People Salmon Arm 6 Fairview Medical Penticton 6 Golden Public Health Golden 6 RIH Healthy Heart Kamloops 5 Dr. Lawrence Weibe Kelowna 5 Grand Forks Public Health Grand Forks 5 Rocky Mountain Health Centre Fernie 5 Royal Inland Hospital Kamloops 5 Selkirk Medical Revelstoke 5 Shuswap Lake Hospital Salmon Arm 4 Dr Keith Merritt Inc Castlegar 4 Trail Public Health aka Kiro Welleness Centre 3 Castlegar Medical Clinic Castlegar 2 Dr. B. Sithembu Castlegar Medical Clinic 1 Riverside Family Medicine Clinic Trail

We can refer more smokers to QuitNow

What is QuitNow?

What is QuitNow?

• Behavioural quit smoking support

• Managed by the BC Lung Association

• Evidence-based • Free, confidential, 24/7 • Contests

Fax Referral Forms Go to www.quitnow.ca to download forms or order pads.

www.quitnow.ca/referral-form

What is Tobacco Free Tuesdays?

A monthly 24 hour quit smoking challenge to:

• Increase quit attempts • Support and motivate smokers to stay quit • Build quit confidence and skills • Learn about free quit smoking services (QuitNow) • A chance to win gift certificates (sponsors change monthly)

“You can do it! Start with a 24hour quit!”

BC Smoking Cessation Program

Dial 811 – Healthlink BC

Free gum or patch

Subsidized medication

84 days of continuous supply per calendar year

Information on QuitNow website

Nicotine Replacement Therapy (NRT)

What is Nicotine Replacement Therapy (NRT)?

It is a type of treatment designed to help people give up smoking by gradually decreasing doses of nicotine.

NRT Products

Common Problems with NRT

• Inadequate dosage

• Inadequate duration

• Rationale not understood

Nicotine Patch

• Remove old patch before applying new one

• Touch only small corner of new patch

• Apply to clean, dry and hairless skin area above the waist, rotating daily

• Ensure complete adherence

Nicotine Gum - How to Use:

• Avoid caffeine/acidic food or drink 30 mins before use

• Rinse mouth before use

• Bite and Park (not like normal gum)

Nicotine Inhaler - How to use:

• Inhale like a cigar, not deeply into the lungs

• Keep the top and bottom plastic pieces

• Clean inhaler pieces on a regular basis with soap and water

Nicotine Mouthspray - How to use:

• Point the spray nozzle towards the open mouth, holding it as close as possible.

• Press the top of the dispenser to release one spray into the mouth, avoiding the lips.

• To avoid getting spray down the throat, don't inhale while spraying.

• For best results, don't swallow for a few seconds after spraying.

Strategies to help your patients quit

• Brief advice to quit smoking • Refer to behavioural support (like QuitNow) • Recommend patients call 8-1-1 for NRT • Remind patients that the more support they have

the greater their success at quitting • It usually takes 7 quit attempts to be successful

E-Cigarettes

What is an E-Cigarette?

Types of E-Cigarettes

Cig A Like (Minis) Mid Size Advanced Personal Vapourizer

Can E-Cigs Help People Quit? E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events.

Bullen et al. Lancet 2013

Public Health/Population Health Concerns

• Dual Use – undermine intention to quit • Health impacts from use and/or exposure to vapour

(not just water vapour) • Visibility may renormalize tobacco use, and trigger

withdrawal among quitters • Nicotine Addiction – appeals even to youth who

wouldn’t use cigarettes • Nicotine Poisoning – especially small children

42

What is the law?

• Non-nicotine e-cigs are legal for sale • Nicotine versions or those that make a health

claim are not authorized for sale in Canada, but are readily available in stores and internet

• No regulation on sales or marketing to youth • No Federal or Provincial restrictions on where

they can be used • No product safety or quality standards

When patients want to use an e-cig to quit Most important: Support the patient’s quit attempt. 1. Discuss a quit plan and if appropriate, approved cessation

medications: NRT, bupropion, varenicline. Refer to QuitNow. 2. If not successful or patient refuses and wants to try e-

cigarettes: • Ensure that patient is aware that products are unregulated,

contain toxins and have not been approved as cessation aids.

• Advise that e-cigarettes should not be used indoors or around others (especially children) and that they should set a quit date for e-cigarette use.

Web: www.quitnow.ca E-mail: quitnow@bc.lung.ca Tel: 604.731.5864 (LUNG) Toll-free: 1.877.455.2233 Text Support: 654321

Contact Us

References

Mayo clinic slides from December 2012 presentation to NAQC

Rachael Grana et al. E-cigarettes A Scientific Review. Circulation 2014; 129: 1972-1986. http://circ.ahajournals.org/content/129/19/1972.full

Electronic Nicotine Delivery Systems: Report by WHO July 21, 2014. http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf?ua=1