Physiotherapists can ´Make Every Contact Count´ to promote smoking cessation; a quality improvement project on a vascular ward

Purpose

Smoking is the greatest cause of preventable death and ill-health. Supporting patients in hospital to quit is recommended in NICE guidelines and is a priority of the NHS long-term plan. It is cost-effective and life-saving.

As health-care professionals, physiotherapists have a responsibility and duty of care to help patients stop smoking. Despite this, 23% of UK physiotherapists do not discuss smoking with patients.

Encouraging physiotherapists to Make Every Contact Count by routinely giving Very Brief Advice (VBA) on smoking cessation, may result in additional referrals to Stop Smoking Services (SSS) and more successful quit attempts.


Many patients with vascular disease smoke. The aim of this project was for therapists to give VBA and offer a referral to local SSS to at least 75% of patients on the vascular ward who smoked.

 

During the intervention period
22% (n=43) of vascular in-patients were recorded as smokers.
83%
(n=36) of these patients received VBA, of which 33% (n=12) were referred to local SSS.
Overall, there was a 50% increase
in SSS referrals from the ward.

Approach

Training was delivered to the vascular therapy team on giving VBA on smoking cessation and how to refer patients to their local SSS.


Between March and August 2018 therapists used the 'Ask-Advise-Act' model for the provision of VBA to patients who smoked.

Assessment forms were updated to record smoking status, whether VBA was given, and the outcome of VBA (i.e. referred to SSS, referred for Nicotine Replacement Therapy (NRT) or declined).

The impact of the initiative was measured by recording the number of SSS referrals and assessing the uptake and outcome of those referrals.

Outcomes

During the intervention period 22% (n=43) of vascular in-patients were recorded as smokers.

83% (n=36) of these patients received VBA, of which 33% (n=12) were referred to local SSS.

17% (n=6) of patients given VBA were referred to ward doctors/pharmacists for NRT.

Overall, there was a 50% increase in SSS referrals from the ward.

Of the 12 patients referred to the SSS, data was unavailable for 3 patients and 3 died. Two patients were unable to be contacted by the SSS, 2 accepted the referral and 2 declined; 1 patient reported quitting independently.

Establishing the public health impact from this follow-up data alone is challenging given the small sample size. However, when combined with other similar studies, it is predicted that in this setting, the number needed to treat (i.e. give VBA) to achieve one successful quit attempt is 42.
 

Physiotherapists are well-placed to encourage and enable patients to quit smoking. By routinely providing brief advice and offering a referral for NRT and Stop Smoking Services, more vascular in-patients were assisted to quit.

Implications

If successfully upscaled and embedded in all therapy teams at the Royal Free Hospital, this intervention is predicted to achieve 97 successful quit attempts and a return on investment of approximately £15,353 in 1 year.

To facilitate this, in-patient assessment forms have been updated and VBA training introduced to new and current therapy staff.

Further work includes recruiting Smoking Cessation Champions to all therapy teams and providing monthly feedback on referral numbers made by therapists.

If the wider physiotherapy work-force embedded this intervention as routine practice it could have a powerful impact on the health and well-being of patients who smoke.

Funding acknowledgements

None

Additional notes

This work was presented at Physiotherapy UK 2019 and a section of this project was presented as a poster at ACPRC 2019.