It is important that Very Brief Advice is embedded in your mind
Darush Attar-Zadeh, a Respiratory Lead Pharmacist in Barnet, and Community Pharmacist, explains why it’s important that Very Brief Advice is embedded in a health care professional’s mind, and elaborates on why he uses an Ask, Advise and Act formula.
Twenty five years ago, when I qualified as a pharmacist, I practiced in the community pharmacist, (CP) sector. Over time, I began to understand that people who smoked primarily did so because it was a behavioural habit for many, something that they do day in and day out. I have focused my career on supporting people to quit smoking.
In 2000, smoking cessation services started in my area. This was a foot in the door for me and a starting point for my interest in smoking cessation. I enjoyed this work and I have mentored peers and trained GPs and nurses in evidence-based techniques on how to help patients stop smoking.
Twenty-one years on, delivering smoking cessation support is still part and parcel of what I do. The patients we recruit on to our NHS programmes are smokers who want to stop, and around half will have tried before over the years. How they stop is important. If they go cold turkey, they will more than likely relapse. Patients using NHS services, including reputable apps, in combination with evidence based medicines, have a much better chance of stopping and stopping for good.
When patients come into the CP looking for smoking cessation products they can buy over the counter or brought in prescriptions for long term conditions (e.g. asthma, COPD, diabetes), I ask them if they smoke or if they are exposed to secondhand smoke. If they do smoke, I talk to them about the additional support available on the NHS that can be tailored to them. I work on the message that ‘you are three more times likely to stop if you get NHS support and treatment’. This is the Advise part of Very Brief Advice (VBA) to help people stop smoking. Another part of VBA is to act on the person’s response and signpost them to the support tailored to them.
VBA should become a natural part of your consultation
I have found ways to weave VBA into conversations naturally. In my role as Respiratory Lead Pharmacist running an asthma clinic, when I am checking a patient's inhaler technique or they are doing a peak flow reading (this is to measure how forcibly a person can blow air out of their lungs), I make sure to find opportunities to discuss their smoking status. I will ask “do you smoke?” or “are you exposed to second-hand smoke?”
If I have a little more time, as an extension to VBA, I’ll introduce my carbon monoxide (CO) machine (when it is safe to do so). I ask the patient “do you know what that is and where you can get CO from?” That’s when a patient will usually say to me, “you can get it from cars, buses and you can get it from cigarettes too.” This conversation often gives me the opportunity to discuss the support they may need to go smoke free and highlight that it only takes 24 hours for the CO level to drop right down to a non-smoker level (please note, this is not a normal part of VBA, which only takes 30 seconds).
The good news is that we do have a lot of support and treatment out there to help people. The support is free on the NHS and the medication is heavily subsidised or free if you don’t pay for prescriptions.
The VBA training I did (as soon as it was launched in 2012), is an evidence-based model from National Centre for Smoking Cessation Training (NCSCT). It is an online module. There is a great, but emotional video of a GP talking to their patient using an Ask, Advise and Act formula. In my role as a pharmacist I use this model with some minor adjustments to suit my setting.
The Primary Care Respiratory Society (PCRS) also has other great examples of how the VBA model can be adjusted to suit the individual patient and how to become a ‘quit catalyst’ for people who would most benefit (e.g. a person with serious mental illness, a pregnant lady, a person attending the GP practice with back pain).
VBA is a simple model, it takes no more than 30 seconds
VBA is important for clinicians to adopt because it is evidence based. We must follow the evidence base. Whether we are working in a pharmacy, or a GP practice or a hospital, a dental practice or as a midwife, it is very important that VBA is brought up regularly and in a way that feels natural to the individual.
The way I look at it is, for every two people we can help stop smoking we prevent one premature death. We cannot do any other intervention that could do that.
It’s a simple model to follow. It’s not preaching to people and it’s not saying it’s bad for you. It’s more on the lines of “we can help you; we can support you”. It’s important that VBA is embedded in a health care professional’s mind when they are qualified as a practitioner.
Most people expect to be asked if they are smoking.If you are awkward when you are doing it, not to worry, keep practising and it will come naturally. For a pharmacist, there are so many opportunities to use VBA. If someone is bringing prescriptions in for inhalers into a pharmacy, or somebody is asking for over the counter cough mixtures, you can easily bring it up and ask someone if they smoke.
Positive encouragement each time you see a patient is also so important. It can sometimes be as little as saying “You can do it” or “Take it one day at a time” or “What a fantastic achievement, four days without smoking!”.
It’s nice when people come back to me a year or two later to say that they are still not smoking. You can see the effect of it in them physically as well as in their health. They feel they can live a better life because they are free of their smoking habit.
The Taskforce for Lung Health, along with Asthma UK and the British Lung Foundation, are calling for training in VBA to be routine for all health care professionals. Read the Taskforce's recommendations for smoking cessation, here.