Physician attitude and practice pattern related to smoking

cessation

Dr. Essam Elmoghazy

Health Hazards of smoking• Tobacco is the leading preventable cause of death in the world

today. It currently leads to the death of one in ten adults. The number of annual deaths is expected to increase to 8 million by 2030.

• Smoking causes a wide range of health conditions and fatal diseases, including cancer, respiratory disease and heart disease.

• It is the most important risk factor for chronic obstructive pulmonary disease and lung cancer.

• Exposure to second-hand tobacco smoke harms health and worsens existing health problems, including respiratory conditions. It causes diseases such as lung cancer, coronary heart disease and cardiac death

Smoking burdenGlobally• The tobacco epidemic is one of the biggest public

health threats the world has ever faced, killing around 6 million people a year. More than 5 million of those deaths are the result of direct tobacco use while more than 600 000 are the result of non-smokers being exposed to second-hand smoke.

Nearly 80% of the more than 1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.

Smoking burdenEgypt:• It is estimated that approximately 20% of the

population uses tobacco products daily.• Cigarettes are the most common form of

tobacco consumption in Egypt, with an estimated 20 billion cigarettes smoked annually in the country.

• After cigarettes shisha are the most common form of tobacco consumption.

Smoking cessation

• Smoking cessation significantly reduces morbidity and mortality.

• Brief tobacco cessation counseling interventions, including screening, brief counseling (3 min or less), and/or pharmacotherapy; have proven to increase tobacco abstinence rates.

• It’s recommended that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products

Golden standards for initiating smoking cessation is the 5 As

Asking about tobacco use,Advising tobacco users to quit,Assessing readiness to make a quit attempt,Assisting with the quit attempt, Arranging follow-up care.

Cessation Options

• Counseling. . Intensive counseling is associated with a 22% rate of quitting, and even minimal (<3 minutes) counseling is associated with a 13% quit rate.

Pharmacotherapy. Two general classes of drugs are approved by FDA for cessation:

1-Nicotine replacements products (NRTs)2-Psychotropic drugs.

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Smoking Cessation Interventions

There are 5 basic ways to help smoking quit: increase the price of a pack of cigarettes by increasing taxes; pass clean indoor air legislation that bans smoking in public places; create and disseminate effective counter-marketing messages about smoking-in the media or as graphic package displays; ban tobacco advertising and promotion; and provide cessation aids.

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Role of physicians• While guidelines recommend all doctors to ask their patients

about their smoking habits and, in case they smoke, offer cessation advice, limited data are available about doctors' attitudes toward these recommendations

• Physicians can contribute largely to efforts to reduce smoking and remain one of the most important sources of information on health risks for patients and their families.

• Many smokers will visit a physician each year , and physician advice and encouragement have been shown to increase the number of patients who will attempt and succeed in quitting smoking.

• Recent studies suggest that physician interventions have the potential to increase abstinence rates to 30% from only 7% among adult smokers attempting to quit on their own

Norwegian hospital doctors• 23% of the doctors found it too time consuming to ask if the

patient smoked, and approximately 35% found it too time consuming to inform or offer help on smoking cessation.

• About 25% of the doctors felt that they did not possess enough knowledge to help the patient to stop smoking, and 65% of the doctors preferred to refer to a specialist for this.

• 28% of the doctors did not see it as their task to help the patient to stop smoking, while 32% did not think it is worth the effort to offer the patient help to stop smoking.

• In conclusion, about one-quarter to one-third of Norwegian hospital doctors seem to disagree with current guidelines that all doctors should address their patients' smoking habits

University of Washington School of Medicine

• A sample of 8229 smokers aged 18 years and older who made at least one visit to a physician in the past year.

CONCLUSIONS:• Physicians continue to miss opportunities to

provide smoking cessation advice, a potentially lifesaving intervention. Given the adverse health consequences of tobacco use and the demonstrated benefit of advice to quit, physicians need to improve their cessation counseling efforts.

A study by the Cancer Control Science Program, National Cancer Institute, Maryland

The potential public health impact of physician intervention with smoking patients is enormous. Even with very modest expectations of cessation rates, 100,000 physicians using effective intervention can produce over 3 million new ex-smokers in the United States each year. In conjunction with other community-based tobacco control efforts, this physician-lead effort will result in a marked reduction in the morbidity and mortality caused by smoking and, thus, control of "the most important public health issue of our time."

KAP Family Physicians Regarding Smoking Cessation Counseling in Suez Canal University

• The present study showed limited knowledge and practice of family physicians regarding smoking cessation counseling.

• Training and lack of time were among the barriers that call for organization support.

• Further, interventional researches are needed to improve and re-evaluate quality of smoking cessation counseling using direct observation of practice.

Conclusions

Decreasing tobacco use will require greater activity on the part of the physicians in cessation activities. This will require increased familiarity with available resources as well as sustained efforts to improve these resources. Specifically, several areas for improvement exist, including:

Increase the availability and use of tobacco control tools • Increase the number of smoking cessation services • Promote physician familiarity with tobacco control

resources as well as how patients can access these services • Provide physicians with additional information on quitlines

and web based resources Increase physician assistance to patients who smoke to reduce their use of tobacco

ConclusionsIncrease physician assistance to patients who smoke to

reduce their use of tobacco • Encourage medical practices to require documentation of

activities undertaken to help patients quit smoking, e.g., documentation of treatment strategies discussed with patients

• Improve physician-patient communication around tobacco use

Improve coverage for tobacco control treatment, services, and physician time

• Expand insurance coverage to include additional cessation treatment and support services

ConclusionsIncrease physician knowledge of tobacco control

interventions • Improve effectiveness of medical school curricula on

tobacco control as part of assisting patients with behavioral changes

• Increase the availability of CME related to smoking cessation and behavioral change

Support investment in tobacco control • Improve linkages between physician associations and

other tobacco control stakeholders to promote collaboration in efforts in to promote the health of citizens in communities

Thank you