Supporting a quit attempt
Completing the VBA will tell you your patient’s self-reported tobacco status – an important first step.
Very Brief Advice (VBA) is our most practical tool to trigger a quit attempt, with structured behavioural support and medical treatment being the best method of quitting and ideally these are provided by stop smoking practitioners.
If smokers are unwilling or unable to attend specialist stop smoking services to quit smoking support can be effectively offered by GPs within a series of standard 10-minute appointments.
The Royal College of General Practitioners (RCGP) have an online course on the delivery of smoking cessation support by GPs consisting of a pre-quit appointment, subsequent weekly, biweekly then monthly appointments over 2 to 3 months and a final visit.
This course is available via the RCGP elearning portal (course name: Essentials of smoking cessation).
The core components of the guidance are summarised below:
- Discuss available treatments and prescribe treatment/s for the first 2 weeks
- Agree and record a quit date
- Check breath carbon monoxide if possible
- Arrange a follow up appointment in one week
Subsequent appointments (continue for 8–12 weeks)
- Discuss treatment and progress
- Ideally check CO
- Prescribe further treatment
- Arrange next appointment
- Congratulate success, encourage and advise on avoiding lapses
- Reassure that the ‘door is always open’ if they go back to smoking
As a clinician you will also be treating people for conditions where management of tobacco dependency is part of the therapy pathway and because the impact of continued use is so serious. You may therefore need to gather more information to help co-create a plan with your patient or indeed find yourself holding information that needs further discussion.
- Women booking pregnancy in England are expected to have an exhaled carbon monoxide recording by a relevant healthcare professional regardless of reported smoking status.
- A joint colleges recommendation led by RCPsych recommends people with severe mental illness have an exhaled CO check at their annual physical review and that smoking is considered at each interaction with the health system.
The best way of determining smoking status is to ask people: “Do you smoke?”
Very Brief Advice (VBA) is a simple and powerful approach designed to be delivered by any healthcare professional