[Smoking cessation in pneumological routine care]

[Potential Savings in Treatment Costs of COPD through Smoking Cessation: Modeling for DMP COPD in Germany - Scientific Action Group on Tobacco Cessation (WAT) e. V.]

Basierend auf Real-life-Daten für die Stadien-Verteilung von COPD-Patienten (GOLD) und den faktischen Stadien-bezogenen Behandlungskosten innerhalb einer bundesweiten Kohortenstudie (COSYCONET) 1 wird modellhaft für das Szenario einer Reduktion der Raucher-Quote in dieser Patientengruppe von 26 % um 10 %-Punkte auf 16 % ermittelt, welchen Einfluss die reduzierte Raucher-Quote auf die Behandlungskosten haben dürfte. Zugrunde gelegt wird die Annahme, dass bei herabgesetzter Raucher-Quote leichtere Stadien (I/II) stärker repräsentiert sind, während sich höhere und kostenintensivere Stadien (III/IV) proportional verkleinern. Die Intervention zur Erreichung der Tabakabstinenz wird für die überschlägigen Modell-Berechnungen kalkuliert mit den typischen Kosten einer leitlinienkonformen Behandlung durch Nutzung eines verhaltenstherapeutischen Gruppen-Entwöhnungs-Programmes und der parallel eingesetzten medikamentösen Unterstützung 23 . Im Ergebnis zeigt sich die mögliche Absenkung der Fallkosten um 10,5 %, wobei reduzierte Kosten bei Komorbiditäten nicht berücksichtigt sind.

The effects of a short-term physician training on smoking cessation in a university pulmonary department

Objective: The objective was to evaluate the effect of a short physician training in smoking cessation on the physicians' performance of smoking cessation interventions. The effects on patients' cessation rates were analyzed as well. A further aim was to identify barriers for providing cessation interventions. The study was conducted in an acute care pulmonology department of a German university hospital. Methods: 24 physicians of the pulmonology department of a German university hospital received a two-hour training in smoking cessation. 109 pre- and 89 post-training group patients were compared with regard to the frequencies of received smoking cessation interventions (Ask, Advise, Assist) and three- and six-month abstinence rates. Physicians estimated their intervention frequencies and gave reasons for not providing cessation interventions. Results: In a multivariable analysis (p<0.05), the physicians' application of "Ask" (OR 3.28, 95% CI 1.13-9.53) and the six-month abstinence rates (OR 2.70, 95% CI 1.24-5.84) were significantly higher in the post-training group. The univariate analysis also showed a significant effect on "Assist" (OR 2.05, 95% CI 1.09-3.87). No significant effect was seen on "Advise to quit". Physicians overestimated their intervention frequencies and reported the patients' low motivation to stop, an oncological disease and palliative care situation as barriers to performing smoking cessation. Conclusion: A short physician training in a hospital department of pulmonology increases the use of guideline-based cessation strategies and may improve cessation rates. The findings show that hospital-based strategies such as physician trainings could be useful in the improvement of smoking cessation. Strategies for overcoming barriers for providing smoking cessation interventions are needed.