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Quitting smoking in partnership with physiotherapy in Queensland

Iwa Yeung, Physiotherapy Project Officer, Princess Alexandra Hospital

Recent research has estimated that smoking kills one in every two long-term smokers. Despite the declining smoking rates among adults in Australia, there has been a steady increase in the total cost of smoking, affecting both adults and adolescents. The recent report on Australian secondary school students’ use of tobacco in 2014 showed the overall rate of current smoking among Australian students aged 12–17 years was 5.1 per cent, around 3 per cent for 12–15 year olds, and 10.3 per cent for 16–17 year olds.

In addition to having smoking bans in both indoor and outdoor public places (five-metre buffer) on Queensland Health (QH) facilities, Metro South (MS) Health actively promotes the smoking cessation smoking cessation initiative by implementing the smoking cessation clinical pathway in inpatients, with the initiative being led by pharmacy departments across MS. The MS smoking cessation initiative tied in with the Queensland Government’s Quality Improvement Payment initiative—where set targets of 60 per cent completion rates of smoking cessation pathway across five MS QH facilities, as well as 75 per cent of inpatient smoking status identification rates, must be achieved in order for MS health facilities to receive full government incentive funding.

Deepali Gupta, Metro South Smoking Cessation Project.

QH smoking cessation clinical pathway is a state-wide initiative which utilises the evidence-based ‘5As’(ask, assess, advise, assist, and arrange) to address smoking cessation for all admitted inpatient smokers. The pathway provides clear information on nicotine replacement therapy (NRT) options to provide treatment for nicotine dependence and a Quitline/GP referral process for ongoing support after hospital discharge. The pathway:
  • ensures a focus on patient outcomes
  • supports the implementation of evidence-based practice
  • reduces duplication by using a standardised approach to clinical care and documentation
  • improves clinical processes to reduce the risk of patient complications and re-admission.
Physiotherapists extend their routine patient care by actively engaging in health promotion on a daily basis.
This pharmacist-led smoking cessation initiative involves education of all medical and allied health staff, including doctors, nurses, social workers, and occupational therapists. The project also includes contributions from the physiotherapy department at the Princess Alexandra Hospital (PAH) to lead the cultural change and to maintain sustainability of the initiative. Since 2014, PAH physiotherapists have been recruited and trained to become smoking cessation champions at the PAH to assist with:

  • screening for smokers and completion rate of the smoking cessation clinical pathway
  • communicating with the nursing and allied health teams to raise awareness of the smoking cessation clinical pathway
  • providing feedback to nurse unit manager regarding performance of pathway completion for each ward
  • feedback concerns and challenges to the smoking cessation project lead officer.
As part of the initiative, smoking cessation champions also receive a ‘quit smoking—ask me how’ promotional t-shirt to raise awareness of the importance of the campaign. Additionally, physiotherapists are also involved in interviewing smokers, as well as providing basic education and information on treatment options available in hospital to address nicotine dependence and tobacco-craving concerns. Working together with the multidisciplinary team of doctors, nurses and pharmacists, physiotherapists extend their routine patient care by actively engaging in health promotion on a daily basis.
All MS staff can access LEAPonline smoking cessation training, which outlines the health problems related to smoking, the benefits of quitting, and provides an introduction to the smoking cessation pathway, and how the combination NRT algorithm works. Additional resources, including a training module on clinical skills development, are also available online.

These educational tools help to dispel the myths about NRTs, as well as updating physiotherapists and other allied health staff with the basic knowledge to effectively communicate with patients who often hang onto the beliefs that NRTs are ineffective or harmful, and may refuse NRTs as a result.

For non-QH physiotherapists, there are abundant online resources that therapists can access. Examples include a website such as Quitnow or online app such as MyQuitBuddy. Any health professional can also access and order free resources, including the Quit because you can booklet, various educational brochures, factsheets, posters and ‘smoke-free healthcare’ stickers. These resources increase the understanding of the risk of smoking, provide methods which assist patients to quit smoking and discuss specialist programs or addiction services where patients can be referred for coaching, counselling or general support.

Health promotion to assist patients to quit smoking is everyone’s responsibility. Physiotherapists are in an ideal position to provide information and advice to people to quit smoking, which in turn assists with reducing morbidities and mortality burdens associated with smoking. I encourage all physiotherapists to take leadership in health promotion, including local workplace promotion of the annual World No Tobacco Day.

For more information regarding the district-wide smoking cessation initiative, or the smoking cessation clinical pathway, contact Iwa Yeung or the Pharmacy Project Lead Officer, Deepali Gupta.


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