Lifestyle management (3): Smoking
Smoking and diabetes
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In the UK smoking kills around 120,000 people a year- that's about one death for every 500 patients in your practice. It kills half of all regular persistent smokers and generates about 1.1 million GP consultations annually. Tobacco dependence is responsible for one in every five UK deaths, a third of all cancers, over 80% of all chronic obstructive pulmonary disease (COPD) deaths and a sixth of all ischaemic heart disease deaths
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There is a growing body of evidence that smoking is an independent risk factor for the development of diabetes as well as contributing to related diseases
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People with diabetes already have an increased risk of heart disease, which is further elevated if they smoke
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There is evidence for increased incidence of other complications in diabetes, such as nephropathy with albuminuria, neuropathy and diabetic retinopathy, in those that smoke
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Smokers need help to quit: Without support, a smoker has a 3% chance of succeeding. With support (including NRT/Zyban and referral to cessation service) this increases to 20% still abstaining after 12 months
Raising the issue
Ask
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Record the smoking status of all patients and, referring to patient notes, raise the issue at least once a year. Refer to Read Codes for appropriate recording of status (smoker, non-smoker, ex smoker, no. of cigarettes smoked daily, etc).
Advise
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All patients who smoke should be given clear, firm, personalised advice on the value of stopping and the risks to health of continuing
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Try asking, "would you like to stop?" and "would you be prepared to try quitting in the next two weeks?"
Assist
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For patients who would like to stop, brief advice covering a few key points can be given in about 5 - 10 minutes. You would need to decide if you can do this at the time or at an additional appointment. Key issues will include:
• Setting a date to stop
• Reviewing past experiences, what helped, what hindered
• Planning - identifying likely problems and making a plan to deal with them
• Telling family and friends to get their support
• Thinking about alcohol - the effect drinking may have on the quit attempt -
Assessing suitability for NRT or Zyban, in line with NICE guidelines
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You may choose to refer the smoker to the specialist Smoking Cessation Service (where it exists). The advisor would be able to spend time going through motivation and advice on products. The smoker would then refer back to you to assess product suitability and for prescription
Arrange follow up
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Refer interested smokers to the Smoking Cessation Service (see below). 6/7 weeks support will be provided through group or one-to-one contact. Repeat prescriptions will be needed (for example, NRT needs to be sustained for about 12 weeks). This is an important opportunity to support the quit attempt and check compliance with and suitability of product
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Relapse is common - most smokers make several attempts to stop before they succeed. Support the patient in making sense of their relapse and encourage them to return for another attempt after an appropriate interval
Dyfed powys smoking cessation service
For leaflets and business cards telephone your local contact
County |
Town |
Advisor |
Phone |
Carmarthenshire |
Carmarthen/Whitland/Llandeilo Amman Valley Llanelli
|
Linda Durgan Glenda Morgan Lynne Otter Carol Chaffer Glenda Morgan |
07980 308683 07980 308684 07980 286342 07980 291472 07980 308684 |
Pembrokeshire |
Pemb Dock/Tenby/Narberth Haverfordwest/Milford Haven |
Noleen Evans Lynne Carroll |
07980 308503 07980 308681 |
Ceredigion |
Cardigan Aberyswyth/Llandyssul/Lampeter |
Pat James |
07980 287062 07980 308620 |
Powys |
Welshpool/Machynlleth/Newtown Ystradgynlais |
Angela Lee Teresa Erasmus |
07980 308502 07980 292648 |