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Smoking cessation

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Nobuaki Endo

on 24 March 2013

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Transcript of Smoking cessation

Idea vs Reality Smoking Cessation Approaches to Preventive Activity [2,3,6] MVA Diseases Caused by Smoking 4125 19000 [1] Australian Health and welfare. Risk factors to health [Internet]. Available at: http://www.aihw.gov.au/risk-factors/. Last accessed 19 March 2013.
[2] Murtagh J. John Murtagh's general practice. 4th Ed. McGraw-Hill Australia Pty Ltd. 2007.
[3] Royal Australian College of General Practitioners (RACGP). SNAP Population health guide to behavioral risk factors in general practice. RACGP. 2004.
[4] Australian institute of health and welfare. Health risk factors [Internet]. 2013 [cited 2013 March 19]. Available from: http://www.aihw.gov.au/health-risk-factors-indigenous/.
[5] Quitline. How to quit [Internet]. 2012 May 30. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/how-to-quit-lp
[6] Sackey JA. Smoking cessation counseling strategies in primary care. Uptodate [Internet]. Available at [http://www.uptodate.com/contents/smoking-cessation-counseling-strategies-in-primary-care?source=search_result&search=smoking+cessation&selectedTitle=4%7E150#]
[7] MIMS online. Champix [Internet]. 2013. [cited 2013 March 20] Available at: https://www-mimsonline-com-au.libraryproxy.griffith.edu.au/Search/AbbrPI.aspx?ModuleName=Product%20Info&searchKeyword=champix&PreviousPage=~/Search/QuickSearch.aspx&SearchType=&ID=78600002_2. Last accessed on 19 March 2013.
[8] Coleman T. Use of simple advice and behavioural support. ABC of Smoking Cessation. BMJ. 2004 February 14; 328(7436): 397–399.
[9] eTG. Nicotine replacement therapy [Internet]. 2013. [cited 2013 March14]. Available at http://etg.tg.com.au.libraryproxy.griffith.edu.au/conc/tgc.htm?id=1cbdc3d425e6b266a3e96cf35ed4b589
[10] eTG. Smoking cessation [Internet]. 2013. [cited 2013 March14]. Available at http://etg.tg.com.au.libraryproxy.griffith.edu.au/conc/tgc.htm?id=1cbdc3d425e6b266a3e96cf35ed4b589
[11] Department of Health and Ageing. Nicotine [Internet]. Available at:http://www.pbs.gov.au/medicine/item/3414Q-4571N-4572P-4573Q-4576W-4577X-4578Y-5465P-5571F-5572G-5573H-9198D
[12] Griffith University. Assessment template for Year 4 GP Preventative Activity. 2013.
[13] Australian Bureau of Statostics. Death in Motor ehicle Accident [Internet] 2313 Jan 29. [cited 2013 March 19]. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4125.0main+features3250Jul%202012 Background Burden of Disease [6] Tobacco Smoking Smoking in Australia[1,6] No of daily smokers (2001)
3.1 million people (19.5%)
21% of Males
18% of Females
14% of Boys
16% of Girls
32% Mental Illness
50% Indigenous Australians Alcohol > 10% 4.9% smoking Cessation
Should Be Managed by GP's [2,3,6] Opportunistic
Intervention 70% of smokers visit every year Depression
Weight Gain
Vivid dream Access to
the Community Relationship Close knowledge of patient's personal and family life Medical
Expertise Ask
Arrange Motivational Interview How to Optimize Success Rate
Cigarette Smoking Cessation [3,5,6,8] Quit Rate Limitations and Barriers
Smoking Cessation [2,4,6,] 5-10 % Relapse 90-95% Quit Rate
20~24% Social
support Problem
Solving Skill Pharmaco
-therapy NRT
Bupropion Family
Quitline Multidisciplinary
Patient Centered Approach
Withdrawal Sx
Side effect Mx Coping skill
Self help material
Counselling GP follow up Alternative
therapy Acupuncture
Hypnotherapy Nicotine addiction
Behavioral Issues
Withdrawal Symptom
Side effects of Medication
Social / Cultural Issues
Time constrain Mortality per Annum [6,13] 50% of long-term users cigarette user
40% of male before 65 years of age
20% of female before 65 years of age 5A Strategy Stages of Change Real life Clinical Case Reference Ms B, 61 year old Med / Surg Hx / Madication / Family Hx : NAD
Allergy : Sulfur products

Social Hx :
Currently single; 3 daughter from previous marriage
Works at a Pet shop
Moderate drinker
Marijuana in the past
GP visit ~3 time a year (Her last mammogram was 15 years ago Ask & Assess ~8 / day, packet a day every fortnight
Started in her late 20s
Social smoker
Low dependence (Fagerstorm test score = 1)
Preparation/action phase
Previous attempt failed Smoking History Advise & Motivational Interview Positive Change Negative Change Expectation Concerns Long-term Health Benefits
Financial Benefit
Greater Social acceptance She feels capable of quitting
Improved Quality of Life Dealing with Craving
Champix Grandson - Secondary Smoking
Daughter - long-term Health
Champix Assist [3,6] Arrange [3,6] Counseling organized
Enrolled in Quit program
Pharmacotherapy - Champix Autonomy
Informed consent Set the Quit Date
Smoking triggers : Social smoking
Formulate coping strategies
Providing self help materials Follow-up in 2 weeks
Full transcript