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Guidelines for preventive activities in general practice 7th edition

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Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

Download the full PDF version of Guidelines for preventive activities in general practice 7th edition (396Kb)

 

Smoking

Smoking age range table
Age 0 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 79 >80
    X X X X X X X X X X X X X X

Smoking status and interest in quitting smoking should be assessed for every patient over 10 years of age.57,220 All patients who smoke, regardless of the amount they smoke, should be:6–9

– asked about their interest in quitting (A)
– assessed whether they are nicotine dependent and if so, offered appropriate pharmacotherapy* (A)
– advised to stop smoking (A)
– offered referral to a proactive telephone callback cessation service such as ‘Quitline’ (A).

Smoking complications
Who is at higher risk? What should be done? How often? Level of evidence and references

Average risk

  • People over 10 years of age


5As
Opportunistically, ideally every visit
I A 57,202,220-223
Increased risk
  • Aboriginal people and Torres Strait Islanders
5As adapted to the cultural setting
Opportunistically, ideally every visit**
III A 221
  • People with a mental illness
 5As and careful use of pharmacotherapy given the significant impact of nicotine on drug metabolism† Opportunistically, ideally every visit** I A 202,222-225
  • Pregnant women
 5As and considered use of pharmacotherapy At each antenatal visit I A 224,226,227
  • People with other drug related dependencies
 5As and highlight specific disease related benefits of quitting Opportunistically, ideally every visit** I A 202,223,225,228
  • People with smoking related disease
 5As Opportunistically, ideally every visit** I A 57,220,223,225,226
  • Parents of young babies and children

5As. If the parent is unable to quit advise to:

  • smoke away from children
  • not smoke in confined spaces with children present (eg. when driving)
 Opportunistically, ideally every visit** I A 204,220,225,227,229

Nicotine dependence:
– ask about time to first cigarette AND number of cigarettes smoked per day. High likelihood of nicotine dependence if smoking within 30 minutes of waking and smoking more than 15 per day
– explore whether the patient had withdrawal symptoms when they previously attempted to quit
** While enquiry about smoking should occur at every opportunity, be aware of patient sensitivity. Remember that nonjudgmental enquiry about smoking is associated with greater patient satisfaction226,228
† See effect of smoking abstinence on medications. NZ Smoking cessation guidelines, 2007. Appendix 9. Available at www.nzgg.org.nz/guidelines/dsp_guideline_popup.cfm?guidelineCatID=53&guidelineID=148

Implementation

At an individual patient level, GPs can influence smoking rates by systematically providing opportunistic advice and offering support to all attending patients who smoke.220,227,229

General practitioners underutilise effective treatment strategies (eg. referral to the Quitline, using pharmacotherapy, and motivational interviewing.220,227,229 A whole-of-practice approach that includes a supportive infrastructure has a big impact on GP effectiveness in smoking cessation.26–28 The ‘green book’ outlines a range of effective implementation strategies in smoking cessation.200


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© The Royal Australian College of General Practitioners
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