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8/6/2019 Dr. Hudoyo - Innovative Partnerships Presentation
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SMOKING CESSATION CLINICSMOKING CESSATION CLINIC
PERSAHABATAN HOSPITAL JAKARTAPERSAHABATAN HOSPITAL JAKARTA
( A partnership model)( A partnership model)
SMOKING CESSATION TEAM, PERSAHABATAN HOSPITAL
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BACKGROUND
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Diseases caused by smoking
WHO report on the global epidemic of tobacco, 2008
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Diseases caused by secondhand smoke
WHO report on the global epidemic of tobacco, 2008
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Tobacco use is a risk factor for six of the eight leading
causes of death in the world
WHO Report on the Global Tobacco Epidemic, 2008
Chronic diseaseChronic disease-- NCDNCD
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SMOKINGSMOKING PREVENTABLE caused ofPREVENTABLE caused of
disease and mortalitydisease and mortality 11
6
3 mortality caused in US smoking
#1 LUNG CANCER#1 LUNG CANCER
#2 ISCHEMIC LUNG DISEASE#2 ISCHEMIC LUNG DISEASE
#3 CHRONIC OBSTRUCTIVE PULMONARY DISEASE#3 CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Cancer
Lung Leukemia
Laryngeal (AML, ALL, CLL)2-4Oral cavity/pharynx Esophageal
Stomach Pancreatic
Kidney Bladder
Cervical
Cardiovascular
Ischemic heart disease
Stroke Vascular dementia5
Peripheral vascular disease6
Abdominal aortic aneurysm
Respiratory
COPD
PneumoniaPoor asthma control
Reproductive
Low-birth weight
Pregnancy complications
Reduced fertility
Sudden Infant Death Syndrome
Other
Adverse surgical outcomes/wound
healing
Hip fractures
Low-bone density
Cataract
Peptic ulcer disease
1. Surgeon Generals Report.The Health Consequences of Smoking. 2004; 2. Sandler DP et al.J Natl Cancer Inst.1993;85:1994-2003; 3. Crane MM et al.Cancer Epidemiol Biomarkers Prev. 1996;5:639-644; 4. Miligi L et al.Am J Ind Med.
1999;36(1):60-69; 5. Roman GC.Cerebrovasc Dis. 2005;20(Suppl 2):91-100; 6. Willigendael EM et al.J Vasc Surg. 2004;40:1158-1165. 6
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Estimated mortality from tobacco use in Australia in 200405
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COPD prevalence by periode of survey publication
Eur Respir J 2007; 30: 993- 1013
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COPD Cases in Persahabatan Hospital 2000 - 2008
0
00
1000
1 00
2000
2 00
2000 2001 2002 2003 200 200 2006 200 2008
Year
Totalcas
es
per
year
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0
100
200
300
400
500
600
700
800
900
1000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
tal
ases
er
ear
Lung cancer Cases in Persahabatan Hospital2000
-2009
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Mortality prevented or postponedMortality prevented or postponed
QuittingQuitting
SmokingSmoking
7235
24680
4710
0
5,
000
10,000
15,000
20,000
25,000
30,000
35,000
Mort lity
reventedor
ost oned (N)
Cholesterol
Reduction
Blood ressure
Reduction
1. Unal Bet al.BMJ. 2005;331:614
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SMOKING CESSATIONSMOKING CESSATION
IS ONE OF MANY WAYIS ONE OF MANY WAYTO PREVENTTO PREVENT
CHRONIC DISEASECHRONIC DISEASE
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SMOKING CESSATION CLINICSMOKING CESSATION CLINIC
PERSAHABATAN HOSPITALPERSAHABATAN HOSPITAL
JAKARTAJAKARTA
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Levels of smoking cessation interventionLevels of smoking cessation intervention
InterventionIntervention
levellevel
SmokerSmoker InterventionIntervention
typetype
Health stafHealth staf
involvedinvolved
FirstFirst
SecondSecond
Healthy smokerHealthy smoker
Healthy smoker,Healthy smoker,
difficult casesdifficult cases
Unhealthy smokerUnhealthy smoker
MinimalMinimal
IntensiveIntensive
MultimodalityMultimodality
Primary carePrimary care
SpecialistSpecialist
(Hospital base)(Hospital base)
SMOKING CESSATION CLINIC AT PERSAHABATAN HOSPITAL
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70 % smoker want to quit but 70 % smoker want to quit but
Only 5%-10% can doit unassisted
1/3 of them try to stop smoking1/3 of them try to stop smoking
each yeareach year
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multidimentionalmultidimentionalwhy difficult ?why difficult ?
Physiology
- icotine addiction
-Withdrawal effect
Psychological
-Behavioral
-Environment
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SMOKING CESSATIONSMOKING CESSATION
THERAPYTHERAPY
Non pharmacology :Non pharmacology :
Psychological therapy and behaviourPsychological therapy and behaviour
therapytherapyCounselingCounseling
-- ShortShort
-- MultiMulti -- session supportsession support
-- GroupGroup Family supportFamily support
PharmacologyPharmacology
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PharmacotherapyPharmacotherapyPharmacotherapyPharmacotherapy
Nicotine replacement therapy (NRT)1
Long acting1-3
Patch
Short acting1-3 Gum
Inhaler
Nasal spray
Sublingual tablets/lozenges
Antidepressant
Bupropion SR4
Varenicline
19
Strenght of evidence = A
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History of smoking cessation clinicHistory of smoking cessation clinic
Persahabatan HospitalPersahabatan Hospital
In 1990In 1990
First time smoking cessationclinic at PersahabatanHospital was declared
Declared by some ofpulmonologist doctor
Place at Asthma Building Concept :
- Counseling
- Without pharmacotherapy
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That clinic vacuum aproximately 18 years
There is no patient
Because drugs medication for smoking
cessation is no available Counselling alone is not effective in patient
perspective
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Okt 2008Smoking CessationTeam atPersahabatan
Hospital weredeclared
November, 7th 2008
re-openingsmokingcessation clinic
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New conceptNew concept
Multimodality
approach
Combined nonpharmacotherapy
and
pharmacotherapy
Continuous
programme
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MOTIVATION (SUPPORT)MOTIVATION (SUPPORT)
ADDICTION & WITHDRAWAL MANAGEMENTADDICTION & WITHDRAWAL MANAGEMENT
FAMILY SUPPORTFAMILY SUPPORT
QUITTERQUITTER
OUR CLINIC STRATEGYOUR CLINIC STRATEGY
FOLLOW UPFOLLOW UP
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Place :Griya Puspa Building,
2nd floor
Time open :
Monday - Friday
09.00 15.00
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StaffStaff
Major
- General Practicioner(2)
- Pulmonologist (3)
- Pshyciatric specialist (1)
- Medical Rehabilitation specialist (1)
Support :
Cardiologist, Internist, radiologist, clinical pathologist,occupational, nutritionist, et.al
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OUR PROGRAMMEOUR PROGRAMME
1. Promotion and prevention programme
- Education, meeting, symposium, training (personal,
group, institution or company)
- Addiction nicotine test
2. Early detection of disease related smoking
- Screening programme for abnormality or disease
correlated with smoking- Consultation with related specialist doctors
3. Smoking cessation programme
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OUR ACTIVITIESOUR ACTIVITIES
Health education
Talkshow
Health effect ofsmoking
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Health education about smoking cessation
Outpatient
clinic
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School
Health education about health effect of
smoking
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Health education about health effect of
smoking
In population
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In company
Health education about health effect of
smoking
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Smoking cessation programmeSmoking cessation programme
Outpatient clinic
Inpatient
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FacilitiesFacilities
Counseling for smoking cessation
- Short counseling
- Pshyciatric counseling
Pharmacotherapy
Behaviour therapy Respiratory rehabilitaion and exercise programme
Withdrawal effect management
Hypnotherapy
Weight gain programme
Measurement of urine nicotine Lung function test
Measurement of CO exhalation
Screening programme for disease related smoking
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SMOKING CESSATION PROGRAMMESMOKING CESSATION PROGRAMME
AT PERSAHABATAN HOSPITALAT PERSAHABATAN HOSPITAL
Initial evaluationInitial evaluation
Short counselingShort counseling
Pshyciatric counselingPshyciatric counseling
Drugs (varenicline)Drugs (varenicline)
11STST
MonthMonth
22NDND MonthMonth
33rdrd MonthMonth
*In selected patient
Telephone counselingTelephone counseling
Behaviour therapy *, Exercise programme *Behaviour therapy *, Exercise programme *
Short counselingShort counselingPshyciatric counselingPshyciatric counseling
Drugs (varenicline)Drugs (varenicline)
Hypnotherapy *Hypnotherapy *
Group counselingGroup counseling Konseling singkatKonseling singkat
Konsultasi psikologisKonsultasi psikologis
Obat (varenicline)Obat (varenicline)Konseling kelompokKonseling kelompok
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Referral system (external)
ClinicClinic
Other healthOther health
facilitiesfacilities
Primary CarePrimary Care
Other hospitalOther hospital
Smoking CessationSmoking Cessation
ClinicClinicPersahabatanPersahabatan
HospitalHospital
CompanyCompany
doctordoctor
PrivatePrivatedoctordoctor
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Lung clinicLung clinic
Asthma ClinicAsthma Clinic
Heart ClinicHeart Clinic
Internal medicineInternal medicine
clinicclinic
Other specialistOther specialist
clinicclinic
Smoking CessationSmoking Cessation
ClinicClinic
Lung wardLung ward
Internal medicineInternal medicine
wardward
Heart wardHeart ward
Other wardOther ward
GP clinicGP clinic
Referral system (internal)
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Symposium
Smoking Cessation
Programme
Workshop
workshop smokingcessation
SYMPOSIUM/TRAININGSYMPOSIUM/TRAINING
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Colaboration with PT Pfizer Indonesia to give
workshop smoking cessation programme for :
- Primary care doctor at Bekasi
- Pimary care doctor at Jakarta- Doctor in company or institution likely Pertamina,
BPKP
- Primary care and private doctor at East Java
- Private doctor at Jakarta- Medical student
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Collaboration with PT Pfizer Indonesia in
Quitter Are Champions (QAC) programme
2009-2010
Free smoking cessation programme 18 participant
100% succes to cessation in 3 month
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Collaboration with PT Pfizer Indonesia in
Quitter Are Champions (QAC) programme in :
- PEMDA Bekasi
- PT Pertamina
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Total patient in 2009Total patient in 2009
Type Total patient Method
Outpatient 26 Counseling +
pharmacotherapy
Inpatient 38 Counseling
Total 64
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Total patient in 2010Total patient in 2010
Type Total patient Method
Outpatient 12 Counseling +
pharmacotherapy
Inpatient 40 Counseling
Total 52
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Total patient in 2011Total patient in 2011
Type Total patient Method
Outpatient 8 Counseling +
pharmacotherapy
Inpatient 24 Counseling
Total 32
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THANKYOU