smoking and rheumatoid arthritis - nras professionals/smoking and ra/ph4830... · smoking and...
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Smoking and Rheumatoid Arthritis:a toolkit for Rheumatology teams
Development and Printing funded by Pfizer Ltd, August 2012. Ref code: NPKAM0050
NHS Fife case study
The Fife Rheumatology smoking cessation campaign targeted patients with Rheumatoid Arthritis to raise awareness of the harmful impact that smoking can have on both their condition and also the treatments used to manage it.
The Rheumatology team worked closely with the local Stop Smoking Service to establish referral pathways, and had support from Pfizer to develop the campaign materials and to aid with implementation. NRAS also provided patient feedback on all the materials suggested, to ensure that the messages and visuals were appropriate.
The campaign encouraged and developed relationships with the local Stop Smoking Service and the Rheumatology team that
hadn’t previously existed. There was also a significant increase in the awareness of the dangers of smoking for patients with RA.
Many Rheumatology teams are now interested in implementing a similar campaign to help support their patients.
Please refer to the full case study document for further information.
Campaign materials
A range of materials have been developed that are available for teams to use. All materials will
be customized with your specific local details. The current documents can be changed to provide
bespoke materials for your specific needs.
Current materials available include:
Objectives for this toolkitThe overall objective of this toolkit is to enable Rheumatology teams to increase the smoking cessation rates of Rheumatology patients. The toolkit will help to raise awareness within the team of the importance of encouraging Rheumatology patients to quit smoking, and offer the best support to help them to do so.
n Posters – raising awareness of the dangers
of smoking and Rheumatoid Arthritis.
n Postcards – for a targeted maildrop.
n 6-page folding leaflet – with further
information for patients to use.
n Guide to help manage the campaign.
n Detailed case study of the NHS Fife
campaign.
Included in this toolkit
n NHS Fife case study
n Campaign materials
n Implementing smoking cessation advice for Rheumatology patients
n Looking at each element
n Glossary
n Background to smoking and Rheumatoid Arthritis
This toolkit has been developed by NHS Fife and Pfizer; both organisations are very keen to help
and support other teams to implement this project. For further information about how they can
support you, please contact your local Pfizer representative.
Dr. Helen Harris, NHS Fife
Implementing smoking cessation advice for Rheumatology patients
All NHS staff that are in contact with patients should be involved in a smoking cessation strategy.
When smoking cessation is not discussed with a patient, it gives the impression that smoking
is not affecting their health. The table below outlines the role and responsibilities of team
members with supporting patients to quit smoking.
Stakeholder Role
Team memberDocument
smoking statusDeliver brief
advicePrescribe
pharmaco-therapyRefer to smoking cessation services
Audit outcomes
Rheumatology Sp Nurse ✓ ✓ If trained ✓ ✓
Rheumatology AHP ✓ ✓ If trained ✓ ✓
Rheumatology Doctor ✓ ✓ ✓ ✓ ✓
Pharmacists (Hospital and Community)
✓ ✓ ✓ ✓ ✓
Rheumatology OPD Nurse ✓ ✓ ✓
NHS Clerical ✓ ✓ ✓
General Practitioner ✓ ✓ ✓ ✓
Dentist ✓ ✓ ✓
Looking at each element
n Documenting smoking status
The first element is to obtain basic information about the patient and simply ask if they
currently smoke.
“Are you a smoker or a non-smoker?”
n Delivering brief advice
Showing an understanding of addiction and displaying empathy is important when asking
smokers questions. A few brief questions can encourage smokers to think about their habit.
“Would you like to stop smoking?”
“Smoking reduces the effectiveness of your treatment.”
”Smokers need higher doses of medications than non-smokers to achieve the same effect.”
n Prescribing pharmacotherapy
Members of the Rheumatology team can prescribe NRT and other medications that help to
support smoking cessation.
n Referring to a Stop Smoking Service
Patients are four times more likely to quit smoking with NHS support than by going it alone.
Referring to a specialist service will ensure they get the best advice and support from trained
advisors. Find out the best method to refer these patients by speaking to your local Stop
Smoking Service.
n Audit outcomes
Rheumatology teams can audit a number of outcomes, including referral rates to smoking
cessation services, number of quit attempts per patient and disease activity of ex-smokers.
This will support the development of smoking cessation targets for Rheumatology teams.
Glossary
Smoking cessation
The process of discontinuing the practice of inhaling a smoked substance.
Brief advice
Term which means offering a small amount of information to help a patient understand their
current smoking behaviour.
Campaign
Used to describe the marketing and promotional materials put together to help raise awareness
of the dangers of smoking in patients with RA.
NRT
Nicotine Replacement Therapy, can be used amongst other treatment options to help a patient
to quit smoking.
Referral pathway
Describes the method and process to pass the details of a patient on effectively.
n How to refer
Different Stop Smoking Services will have different methods of capturing referrals. It’s best if
the Rheumatology team contact the local Stop Smoking Service directly, as they will probably
have referral forms and processes that they can share. Usually, Stop Smoking Services have a
set referral form that Rheumatology teams can use to refer their patients.
n Treatment options
There are various treatment options available to help people give up smoking. An intensive
behavioural support programme of six to seven sessions, combined with twelve weeks of stop
smoking medication, increases the likelihood of success by up to four times7. Alternatively
one-to-one support can be provided by many Smoking Cessation Teams.
Please contact your local Stop Smoking Service for further information about prescribing
smoking cessation medications.
The Cochrane Collaboration is a well-established, non-profit organisation, dedicated to
making up-to-date and accurate information about the effects of health care interventions
available. This is a good resource for Rheumatology teams to use, to understand more about
the effectiveness of smoking cessation therapies and the various treatments available.
www.cochrane.org Background to Smoking and Rheumatoid Arthritis
References1. Sugiyama et al. Impact of smoking as a risk factor for developing rheumatoid arthritis: A meta-analysis of observational studies: Ann Rheum Dis 2010;69:70-81. 2. Manjari Lahiri et al. Modifiable risk factors for RA: prevention, better than cure? Rheumatology 2012;51:4995123. Ulf Müller-Ladner et al. Cardiovascular risk management in patients with inflammatory arthritis: what is good for the joint is good for the heart and vice versa! F1000
Medicine Reports 2010, 2:27 (doi:10.3410/M2-27)4. Saevarsdottir et al. Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors:
Observations from the epidemiological investigation of rheumatoid arthritis and the Swedish rheumatology register cohorts: Arthritis & Rheumatism 2011;63:26-36.5. Abhishek et al. Anti-TNF-[alpha] agents are less effective for the treatment of rheumatoid arthritis in current smokers: Journal of Clinical Rheumatology 2010;16:15-18.6. Masdottir B. et al. Smoking, rheumatoid factor isotypes and severity of rheumatoid arthritis Rheumatology 2000; 39:1202-1205.7. West R, McNeill A and Raw M (2000) ‘Smoking cessation guidelines for health professionals: an update.’ Thorax 55(2):987–99
n Heavy smoking can increase the risk of
developing RA by up to 100%1.
n RA patients that smoke may have a higher
risk of cardiovascular disease2, 3.
n Smoking can weaken the effectiveness
of RA medication4, 5.
n RA may be more severe in smokers than
non-smokers6.
n Quitting smoking is one of the best things
patients can do for their RA1 - 6.