PowerPoint Presentation Chiến Lược can thiệp ngừng hút thuốc các giải pháp của Bác sĩ Gia Đình GS TS BS Lê Hoàng Ninh Vấn Đề / rào cản 1 Can we can paid? 2 Should we simply refer out to quitlines and[.]
Chiến Lược can thiệp ngừng hút thuốc: giải pháp Bác sĩ Gia Đình GS TS BS Lê Hồng Ninh Vấn Đề / rào cản Can we can paid? Should we simply refer out to quitlines and internet sites? Is there a role for us as physicians? 3.What about the patient who does not want to quit? What we have to offer for those who want to quit? What really works? How can we reduce relapses? Chiến lược ngừng hút thuốc người trưởng thành Patient/Physician Partnership for Tobacco Cessation Mục tiêu học tập • Learn a simple motivational intervention for behavioral change • Outline effective behavioral modification strategies for patients with nicotine addiction/dependence on smoking • Describe the pharmacologic interventions useful for smoking cessation • Discuss the issues in reimbursement for smoking cessation • ICD-9 Code: 305.1 (Tobacco Dependence) • Medicare covers minimal counseling ( 10 min) • Payment 12.46 and 20.17 dollars For more information, see: http://www.endsmoking.org/resources/reimbursementguide/pdf/ reimbursementguide-3rd-edition.pdf (General Coding) www.cms.hhs.gov/MLNGenInfo (Medicare) Family Doctors can Help Variety Some patients quit on their own Quit lines have up to 30% success for those patients who use them Those with underlying mental health problems have a great deal of difficulty quitting Those with chronic psychiatric problems die 20 years earlier than expected, mainly due to SA including tobacco Need intensive treatment Smoking and Depression: A Common Combination • Persons with psychiatric conditions are twice as likely to smoke as general population1 • in smokers is depressed and smokes to selfmedicate2,3 • Tailored psychotherapy or combined psycho- and pharmacotherapy more likely to result in abstinence4,5 • Bupropion indicated for treatment of depression and smoking cessation Sources: 1el-Guebaly N, et.al Psychiatr Serv 2002;53:1166-1170; 2Rakel RE, Blum A In: Rakel R, ed Textbook of Family Practice 6th ed Philadelphia: WB Saunders; 2002:1523-1538; 3Anda RF, et.al JAMA 1990;264:1541-1545; 4Brown RA, et al J Consult Clin Psychol 2001;69:471-480; 5Hitsman B, et al J Consult Clin Psychol 1999;67:547-554 SMOKING AND ALCOHOL ... important factor in their success 20% quit for months or more, and after the study, many others quit At end of studies patient who had not been successful indicated reasons why? They were also... Quitting • Substantially reduces risk of all-cause mortality among patients with coronary heart disease1 • Significantly decreases mortality among those who have had a myocardial infarct2 • Substantially... those who quit and 62% of those relapsed before months) Something hopeful Eight months after the study half of the physicians said that patients who had previously failed tried again and succeeded