Primary health care nurses are highly respected sources of health information. Advice from a trusted health professional is known to be a major trigger for prompting a person who smokes to make a quit attempt, and a brief advice conversation with a patient about their smoking can be fast, simple and effective.
Quit’s 3-step brief advice model, Ask, Advise, Help (AAH) focuses on identifying patients who smoke and connecting them to evidence-based tobacco dependence treatment: multi-session behavioural intervention through Quitline and approved pharmacotherapy.
If clinically appropriate:
Ask all patients about smoking status and document this in their medical record.
Advise all patients who smoke to quit in a clear, non-confrontational and personalised way, and advise of the best way to quit.
Help by offering all patients who smoke an opt-out referral to behavioural intervention through Quitline (13 7848), and by prescribing (or helping patients to access) approved pharmacotherapy, such as nicotine replacement therapy (NRT).
Assessment of a patient's motivation to quit smoking is not required and brief advice should be offered at every clinically appropriate opportunity.
Learn more about using the AAH model with your patients using this practical guide for primary care nurses.
The best way to quit is to combine brief advice from a primary care nurse with behavioural intervention (such as Quitline), and pharmacotherapy as clinically appropriate. Behavioural intervention helps people to identify their triggers for smoking, develop practical strategies and shift their self-identify from someone who smokes to someone who doesn’t. Pharmacotherapy helps to reduce cravings and withdrawal symptoms.
Primary care nurses can partner with Quitline in providing best practice care.
Quitline is a confidential, evidence-based telephone counselling service. Quitline is tailored to meet the needs of priority populations including patients living with a mental illness, pregnant people and young people. The Aboriginal Quitline is provided by counsellors who are Aboriginal and/or Torres Strait Islander. Quitline has provision to assist individuals with hearing or speech impairment or for people needing an interpreter.
Quitline counsellors are counselling professionals who use behaviour change techniques and motivational interviewing. Over multiple calls, Quitline counsellors use core counselling skills to help people plan, make and sustain a quit attempt.
There is evidence that making a proactive referral to Quitline, rather than simply recommending your patient to call will result in a 13-fold increase in the proportion of patients using behavioural intervention in a quit attempt.Make a referral to Quitline
Smoking cessation pharmacotherapies include nicotine replacement therapy (formulations include nicotine patch, gum, lozenge, inhalator, mouth spray), varenicline and bupropion. These medications have been approved by the Therapeutic Goods Administration (TGA) for efficacy, safety and quality.
Patients are more likely to stop smoking when pharmacotherapy is combined with behavioural intervention (Quitline).
Learn more about the best smoking cessation pharmacotherapy for your patient, based on clinical suitability and reasons to prefer, using the flowchart in the practical guide for primary care nurses.
NRT is effective and can increase 6–12 month abstinence rates by 6% compared to placebo.
There are different formulations of NRT:
Transdermal – nicotine patch
Faster-acting – nicotine gum, lozenge, inhalator and mouth spray
Combination therapy is using a nicotine patch together with a faster-acting formulation. Combination NRT can increase 6–12 month abstinence rates by 5% compared to using a single formulation of NRT.
Nicotine patch, lozenge and gum are currently subsidised by the Pharmaceutical Benefits Scheme (PBS). All formulations of NRT can be accessed over the counter through pharmacies and supermarkets.
Learn more about using NRT for your pregnant patients using this guideline developed by Quit and Alfred Health, in collaboration with the Royal Women’s Hospital Pharmacy Department.Access videos outlining how to use each formulation of NRT
Varenicline is an oral, non-nicotine medication developed specifically for smoking cessation. Varenicline is effective and can increase 6-12 month abstinence rates by 15%. Varenicline is equally effective as combination NRT and more effective than bupropion or using one formulation of NRT alone. Please note that Champix is currently unavailable in Australia.
Bupropion is an oral, non-nicotine medication. Bupropion is effective and can increase 6–12 month abstinence rates by 7%. Bupropion has similar efficacy to using one formulation of NRT alone and is less effective than combination NRT and varenicline.
Nicotine vaping products (NVPs)
Nicotine vaping products contain liquid nicotine designed to be inhaled using a vaping device. From 1 October 2021, patients require a prescription for NVPs (this includes products purchased both in Australia and imported from overseas).
There are currently no TGA-approved NVPs registered in the Australian Register of Therapeutic Goods (ARTG). This means that NVPs have not been assessed by the TGA for safety, quality and efficacy.
NVPs are not first-line treatments for smoking cessation. There is limited evidence for the effectiveness of NVPs for smoking cessation and their long-term health impacts remain unknown. If NVPs are considered clinically appropriate for a quit attempt, multi-session behavioural intervention (Quitline) is recommended.
There is limited evidence for the most effective way to cease NVPs.
Clinically significant drug interactions occur with tobacco smoke.
This Drug interactions with smoking table lists medications and drugs that require dosage adjustments when smoking is stopped.
Patients should be regularly monitored with regard to their smoking status and doses of relevant drugs adjusted accordingly.
Last updated: 2 December 2022