First patient roadmap for prescribing NVPs

Six steps to prescribing NVPs: The process after receiving your AP approval

Nicovape Q treatment objective: To stop your patient from inhaling tobacco smoke as quickly as possible. The harm from smoking comes from inhaling the toxins released by combustion, not the nicotine.

Nicovape Q treatment objective: To stop your patient from inhaling tobacco smoke as quickly as possible. The harm from smoking comes from inhaling the toxins released by combustion, not the nicotine.

1. Good Clinical Practice

   Ensure that your clinic | practice has incorporated all the elements of Good Clinical Practice required to support prescribing NVPs under the Authorised Prescriber scheme, including:

   • Patient informed consent form.
   • Patient assessment questionnaire.
   
   Template documents are available from medical@liber.com.au and may be uploaded to your practice management software.

2. Identify suitable patients for NVPs

   According to the RACGP’s smoking cessation guidelines (available here), an appropriate candidate:

   • Is an adult smoker who is motivated to quit. • Who has attempted to quit smoking with the aid of pharmacotherapy, but continues to smoke.

   New patients may be:

   • A smoker seeking to quit:

   − The primary goal of treatment is to stop this patient from smoking as quickly as possible.

   • A current vaper and former smoker:

   − The primary goal of treatment is to ensure this patient does not relapse to smoking.

   • A current vaper and never smoker:

   − The primary goal of treatment is to ensure they can access nicotine in a supervised manner and get support to quit nicotine use.

   All three patient types may be eligible to be prescribed NVPs at your clinical discretion.

3. Formulate and document a collaborative cessation plan with mutually agreed upon goals

   • Agree upon a start date and support plan. 

   • Provide NVP use education and resources.
   • Discuss ongoing review plan and support strategy.
   • Dual use stoppage date. Note: Dual use may be tolerated during a (4-week) short transition period but should be discouraged.
   • Patients to be encouraged to have a “buddy” or support person.
     
     

4. Product selection

   The RACGP’s smoking cessation guidelines recommend:

   • Prescribing closed system NVPs for most patients.
   • To avoid open system NVPs, except with experienced vapers.
   • To avoid disposable devices.

   To understand more about selecting the appropriate NVP for your patients, please see Module 12: Questions you need to ask before prescribing an NVP brand.

5. How to prescribe

   Please see Module 9: Prescribing Nicovape® Q.

6. Patient follow-up

   There is strong evidence that ongoing and regular support from a healthcare practitioner significantly increases a patient’s likelihood of quitting smoking.

   • Evidence shows more frequent patient contact during quitting, providing counselling and support, results in improved outcomes.
   • Set a follow-up consultation four weeks from the initial consultation.
   • Check-in with the patient weekly initially – this consult is well suited to telehealth review.
   • Encourage the patient to move to solus NVP use as quickly as possible, and no later than an agreed date.
   • Setting goals around limiting dual use is essential.

Prescribing NVPs via telehealth: GP clinic essentials

Under the regulatory framework governing nicotine vaping products (NVPs), the TGA has acknowledged the role that telehealth platforms provide, particularly post-COVID, in providing greater access for patients to specialist clinical services.

The role of telehealth

Telehealth has a critical role to play in helping to maximise the potential of NVPs in supporting smoking cessation by providing patients with access to high-quality assessments.

To facilitate this, the TGA has streamlined the process by which authorised prescribers of nicotine (APs) can assess smokers with a history of failed quit attempts, or aid patients to manage nicotine dependence.

Educational resources

As part of its ongoing dialogue with practitioners and other stakeholders, Liber has identified particular considerations that are pertinent to the telehealth assessment and prescribing of NVPs.

As part of its ongoing education efforts, and based on feedback from APs who have prescribed NVPs, Liber has prepared guidance about the assessment and dispensing of NVPs.

These documents are designed to help clinicians to better understand NVPs, the Nicovape Q and how they can be best used with your patients:

Practical guidance

Liber acknowledges that NVPs are a second line treatment as set out in the RACGP’s updated Smoking Cessation Guidelines, and are to be used for motivated smokers with a history of failed quit attempts using other first-line treatments.

This document aims to provide practical advice for telehealth providers when prescribing as an AP, much of which have been gleaned from the large-scale medical cannabis telehealth providers and are designed to optimise the patient experience, ensure high-quality care and adherence to regulations and provide mechanisms to support expansion and efficiency of existing services.

Prescribing NVPs via telehealth

The nature of the provision of specialised telehealth clinical services for smoking cessation, or nicotine dependence, is that the presenting problems are narrow in scope, and there is a repetitive, routine nature to the consults.

Systems that are designed to standardise a quality reproducible experience for the patient ensure maintenance of positive patient experience and high clinical standards.

Liber has created a data room containing a series of documents to consider when assessing patients and prescribing NVPs including the following: