Authors (including presenting author) :
Lai FSP, Choi CMC, Tam JH, Ha LM, Leung SH, Li YC
Affiliation :
Department of Family Medicine and General Outpatient Clinics (GOPCs), Kowloon Central Cluster (KCC)
Introduction :
Smoking is an important risk factor of cardiovascular disease and is associated with a worse outcome in COVID-19 infection. During the pandemic in Hong Kong, patients tended not to attend our GOPCs in person to avoid contracting any diseases. They preferred to simply refill their medications and this rendered the recruitment of smokers to attend the Smoking Cessation and Counselling Program (SCCP) a great challenge. Furthermore, the suspended usage of CO analyzer and COPD-6 spirometry have made it even more difficult to motivate smokers to quit. Nursing manpower deployment to manage COVID-19 related work duties also led to limited ad hoc counselling. Under such special and difficult circumstances, some counteracting measures had to be implemented to our SCCP.
Objectives :
Equip smoking counsellor to provide smoking cessation services during the COVID pandemic
Methodology :
Methodology
Reinforce the knowledge and skills for our nursing staff
Meetings were held by “Zoom” to practice social distancing measures. Two zoom educational classes were conducted in early 2021. The objectives were mainly to reinforce the importance of smoking cessation during the pandemic and to refresh the counselling skills in smoking cessation, particularly in the prescription of Nicotine Replacement Therapy (NRT).
Frontline counsellors meeting
This meeting provided a platform for counsellors to share their experiences and difficulties during the pandemic and was effective in alleviating their concerns. The benefits of smoking cessation during the COVID-19 era were emphasized. The skills in identifying the stage of change were stressed as smokers are prohibited to smoke due to government regulations on wearing of masks. This in turn provided us a golden opportunity to promote smoking cessation especially among the working class.
It was reflected that many smokers were unwilling to return to clinics for counselling or NRT despite having high Fagerstrom scores and withdrawal symptoms. Telephone counselling was promoted to overcome this obstacle.
The use and prescription of NRT
Smokers who are willing to quit will be assessed and encouraged to use NRT if not contraindicated. Given the exceptional circumstances, our SCCP team had agreed to extend the prescription period of NRT. Accordingly, this lowered the attendance rate of patients returning to our clinics for refilling their NRT medications. Withdrawal symptoms will be further assessed during telephone follow up, and therapy compliance will also be emphasized by telephone counselling.
Result & Outcome :
Results
From 4/2020 to 3/2021, 2,694 patients have attended the SCCP. The attendance had increased compared with previous years. Telephone follow-ups had also slightly increased while the total NRT prescription remained similar. The clinic follow-ups attendance had decreased in 2020 compared with 2019. Around 65% of attended smokers decreased the cigarette consumption of more than 5 cigarettes/day. The average quit rate in 2020 was 66.7%, which is much higher than that in 2019 ( 62.4%) The quit rate for those under 65 years old was also significant increased from 60.2% to 66.9% (P=0.04).
Conclusion
The COVID-19 pandemic had imposed a great challenge to various aspects of the health care system including the SCCP in primary care. With regular educational meetings and refreshment courses for counselors, they are better equipped to provide smoking cessation services during the pandemic. This had been reflected by the increase in quit rate and the decrease in cigarette consumption. These reinforcement measures in SCCP were proved to be effective during the fight against the COVID-19.
