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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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