ANTI-SMOKER CAMPAIGN - FROM REPRESSION TO PREVENTION

Observations from Own Practice

MUDr. Zuzana Miškovská, General Practitioner 
Contribution presented at the Spring Interactive Conference of the Society of General Medicine, Czech Medical Association ofJ.E. Purkyně, Prague, March 2007

Smoking is the main risk factor of many diseases — oncological, cardiovascular, and it impairs the progress and the recovery of a number of other illnesses. The fight against smoking is thus an essential part of medical prevention. The success of anti-smoker campaigns depends on many factors: on the tolerance of the society towards smoking, including legislation, on the health awareness of the population, as well as on the work of physicians, particularly in terms of primary care.

The Czech Republic is currently (article written on February 25, 2007) in a somewhat schizophrenic position, the society is relatively well informed on the harmfuiness of smoking, however, the efforts aimed at reducing nicotinism have not been backed by legislation so far. The method of working with smokers is determined by the doctor — patient relationship . Until the early 1 990s, the paternalistic model had been prevailing in Czech medicine — i.e. the physician gaye orders and the patients either obeyed (the fight with the habit was completely under their direction), or did not obey (and faced reproach in case of severe health complications — that they were to blame for everything and that they should pay for the treatment themselves).

Till lately, the methods of working with smokers — i.e. ascertaining patient history, education, monitoring the success rate — were relying on the empirical eXperience of each individual physician. A Recommended Procedure for Smoking Withdrawal is being currently implemented in the Czech Republic, which is based on a system of short interventions. These short interventions were proven as efficient by a pilot project that had preceded the Recommended Procedure in 2005. The contribution to the overall society as well as the effectiveness of the Recommended Procedure should be known at a later stage.

Apart from participating in the pilot project, aiso eXperience from my own family — i.e. a recent detection of an oncological disease in a smoker — has reflected itseif in my G.P. practice.

I browsed throuh my medica! files as well as throuh my conscience and I found out that until 2005

1. I recorded the smoker status within prevention eXaminations with 15% of patients
2. Records on non-smoking education

•  Not within the scope of prevention examinations
•  Included only in the event of air passage complications
•  Not included in case of other diseases, e.g. cardiovascular

   3.  Patients who gaye up smoking: 3 in 12 years (i.e. 0.25 p.a.)

Since 2005

1. Records within prevention eXamination — smoker status indicated with 83% of patients
2. Records on non-smoking education included 

• Within the scope of prevention eXaminations 
• Repeatedly

Entries on progress — green “1“ (for 1 month of abstinence) and red “1“ (afer 1 year of abstinence)

  3. Patients who gaye up smoking: 8 (i.e. 4 p.a.)

Conclusion from my G.P. Practice: Prevention is 16 Times more Effective than Repression 

For illustration, I present two cases from my G. P. practice.

Case 1:

• Male, born 1941
• Initial prevention eXamination in my surgery in 1995, without any smoking record
• First record of smoking appears during an eXamination concerning lengthy progress of an infection of the air passages — strict NON-SMOKING RECOMMENDATION given. No record of the method of cooperation or compliance
• Additional records
• 1998: claudication, afler 100 — 150 m of walking — atrophic changes of the skin and the skin adnexa, probably ischaemic disease of lower limbs, NON- SMOKING advice, sent to vascular department;
• 2001: a notice arrived by mail from the hospital infonriing that the patient is hospitalised for a bronchogenic carcinoma;
• 2003: a notice arrived by mail from the health insurance company informing of
• the termination of insurance dne to the death of the patient.

 

Case 2:

• Male, born 1937
• Initial prevention eXamination in my surgery in January 2006, record of nicotinism, short interview with the patient
• Additional records:
• January: good motivation;
• January: discussion relating to treatment methods;
• February: patient attempts to give up smoking, does not know whether he will succeed; patient praised for his attempt to withdraw from smoking;
• March: support during the smoking withdrawal phase;
• April: patient praised for abstaining from smoking for 1 month, green “1“;
• February 2007: patient praised for abstaining from smoking for almost 1 year, red “1“, patient‘ s wife came to inqnire about the non-smoking efforts of her husband.

Conclusion: 
The success of non-smoker activities largely depends on the chmate in the overall society, on the availability of information for the laic public, and last but not least, on the method of work of the G.P., on the physician‘s partner approach to patients and mainly on the physician‘s knowledge ofthe Recommended Procedures and on the effectiveness oftheir implementation.