MINIMAL INTERVENTION STRATEGY QUITTING SMOKING MIS

MINIMAL INTERVENTION STRATEGYQUITTING SMOKING

MIS

Wim Willems

HOVUmc

Smoking kills

Smoking kills

Cause of death Percentage caused by smoking

Lungcancer %

Asthma / emfysema %

Coronary heart disease %

Stroke %

Total %

Smoking kills

Cause of death Percentage caused by smoking

Lungcancer 82 %

Asthma / emfysema %

Coronary heart disease %

Stroke %

Total %

Smoking kills

Cause of death Percentage caused by smoking

Lungcancer 82 %

Asthma / emfysema 68 %

Coronary heart disease %

Stroke %

Total %

Smoking kills

Cause of death Percentage caused by smoking

Lungcancer 82 %

Asthma / emfysema 68 %

Coronary heart disease 32 %

Stroke %

Total %

Smoking kills

Cause of death Percentage caused by smoking

Lungcancer 82 %

Asthma / emfysema 68 %

Coronary heart disease 32 %

Stroke 42 %

Total %

Smoking kills

Cause of death Percentage caused by smoking

Lungcancer 82 %

Asthma / emfysema 68 %

Coronary heart disease 32 %

Stroke 42 %

Total 49,7 %

Quitting smoking is cost effective

Costs per year of life gained

Treatment of high cholesterol in diabetics € ......

Treatment of high blood pressure € ......

Advice to quit smoking + nicotine replacement therapy

€ ......

Quitting smoking is cost effective

Costs per year of life gained

Treatment of high cholesterol in diabetics € 14520,--

Treatment of high blood pressure € ......

Advice to quit smoking + nicotine replacement therapy

€ ......

Quitting smoking is cost effective

Costs per year of life gained

Treatment of high cholesterol in diabetics € 14520,--

Treatment of high blood pressure € 4540,--

Advice to quit smoking + nicotine replacement therapy

€ ......

Quitting smoking is cost effective

Costs per year of life gained

Treatment of high cholesterol in diabetics € 14520,--

Treatment of high blood pressure € 4540,--

Advice to quit smoking + nicotine replacement therapy

€ 430,--

Negative cognitions of GP’s

Negative cognitions of GP’s• I cure, prevention is not my business

• I don’t have the time, I am too busy already

• It’s energy lost, smokers just don’t quit

• I don’t where to begin and how to do the follow up

• It’s too difficult, it’s almost psychotherapy

• Patients don’t want me to confront them with their smoking habits

• I smoke myself, how do I make a credible story?

GP’s effectiveness

Method % success 1 yr.

net result

% success 1 yr.

cumulative result

Spontaneous

MIS (no NRT)

MIS + NRT

GP’s effectiveness

Method % success 1 yr.

net result

% success 1 yr.

cumulative result

Spontaneous 2,5 % 2,5 %

MIS (no NRT)

MIS + NRT

GP’s effectiveness

Method % success 1 yr.

net result

% success 1 yr.

cumulative result

Spontaneous 2,5 % 2,5 %

MIS (no NRT) 5 % 7,5 %

MIS + NRT

GP’s effectiveness

Method % success 1 yr.

net result

% success 1 yr.

cumulative result

Spontaneous 2,5 % 2,5 %

MIS (no NRT) 5 % 7,5 %

MIS + NRT 2,5 % 10 %

MIS

• Motivation dependent --> tailor-made

• Short and systematic

• Delegation of tasks possible

• Respects autonomy of patient

• Non dependent on patient’s complaints

• Patient is active, doctor follows

MIS

MIS 1 Happy smoker

MIS 1 Happy smoker

Motivation?

Have you ever considered to quit smoking?

Do you want to quit in the near future?

1 yes --> Motivation +

2 no --> Motivation -, general advice to quit,

information

MIS 2 Considers to quit

1. Smoking profile (nicotine dependency)• do you smoke 10 cigarettes a day or more?• do you smoke your first cigarette within 30

minutes of waking up?2. Increase motivation (“I want to quit”)• advantages of quitting• disadvantages of continuing• challenge excuses3. Barriers (“I can quit”)• increases self-confidence

MIS 3 Decision

• fix a date within 1 to 2 weeks

• convenient

• informative material, NRT, other medication

• new appointment shortly after quitting

MIS 4 Action

MIS 4 Action

• experiences thus far

• congratulations / praise

• relapse prevention

motivation?

barriers?

at least one new appointment after 2-3 months

MIS 5 Relapse

• Too bad, but nothing is lost• Positive affirmation (you tried, you succeeded)• Causes?• Motivation for a new try?• Barriers?• New appointment?

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