Why do physicians lack engagement with smoking cessation treatment in their COPD patients? A multinational qualitative study

Smoking cessation is the only effective intervention to slow down the accelerated decline in lung function in smokers with chronic obstructive pulmonary disease. Nevertheless, physicians often do not routinely provide evidence-based smoking cessation treatment to their patients. To understand underlying reasons, we explored how physicians engage in smoking cessation treatment in their chronic obstructive pulmonary disease patients. In total, 21 focus group discussions were held with general practitioners and pulmonologists in seven different countries in Europe and Asia. We generated three themes, whereby some of the issues concerned smokers in general: first, ‘physicians’ frustration with chronic obstructive pulmonary disease patients who smoke’. These frustrations interfered with the provision of evidence-based treatment and could result in this group of patients being treated unequally. Second: ‘physicians’ limited knowledge of, and negative beliefs about, smoking cessation treatment’. This hindered treating smokers effectively. Third: ‘healthcare organisational factors that influence the use of smoking cessation treatments’. Money and time issues, as well as the failure to regard smoking as a disease, influenced how physicians engaged in smoking cessation treatment. Our results indicate that there is a number of barriers to the provision of effective smoking cessation treatment in patients with chronic obstructive pulmonary disease and smokers in general. Introducing an informative smoking cessation programme, including communication skills and ethical issues, in the vocational and postgraduate medical training may help to address these barriers. This is important in order to increase engagement with smoking cessation treatment and to improve quality of chronic obstructive pulmonary disease care

Prev Chronic Dis

IntroductionUncertainty about levels of employee use of an insurance benefit for smoking-cessation treatment has presented a barrier to employers considering the adoption of such coverage. This study examined self-reported awareness and use of a new insurance benefit for smoking-cessation treatment among a sample of Wisconsin state employees, retirees, and adult dependents.MethodsWe evaluated the self-reported use of insurance coverage for smoking-cessation treatment during the first 2 years of its availability to the Wisconsin state employee, retiree, and adult dependent population. We conducted analyses of responses to smoking-related questions in 2001 and 2002 cross-sectional surveys of insured state employees, retirees, and adult dependents, weighted to represent this population.ResultsIn 2002, benefit use among smokers aware of the benefit was 39.6%, and benefit use among smokers unaware of the benefit was 3.5%. Only 27.4% of smokers were aware of the benefit in 2002; use among all smokers was 13.6%. Of all smokers, 30.4% used smoking-cessation treatment medication (over-the-counter or covered) in 2002. Smoking prevalence was 15.6% in 2001 and 13.2% in 2002.ConclusionIn an educated employee population, self-reported smoking-cessation treatment benefit use was modest among all smokers during its first 2 years of availability. Benefit awareness was low in this educated population, which may help explain low use rates, particularly given the 30% of all smokers who attempted to quit smoking with the help of smoking-cessation treatment medication. These data provide use-rate estimates for states contemplating adoption of an evidence-based smoking-cessation treatment benefit.2005680

Views about integrating smoking cessation treatment within psychological services for patients with common mental illness:A multi-perspective qualitative study

Background: Tobacco smoking rates are significantly higher in people with common mental illness compared to those without. Smoking cessation treatment could be offered as part of usual outpatient psychological care, but currently is not. Objective: To understand patient and health care professionals' views about integrating smoking cessation treatment into outpatient psychological services for common mental illness. Design: Qualitative in‐depth interviews, with thematic analysis. Participants: Eleven Improving Access to Psychological Therapies (IAPT) psychological wellbeing practitioners (PWPs), six IAPT patients, and six stop smoking advisors were recruited from English smoking cessation, and IAPT services. Results: Patients reported psychological benefits from smoking, and also described smoking as a form of self‐harm. Stop smoking advisors displayed therapeutic pessimism and stigmatizing attitudes towards helping people with mental illness to quit smoking. PWPs have positive attitudes towards smoking cessation treatment for people with common mental illness. PWPs and patients accept evidence that smoking tobacco may harm mental health, and quitting might benefit mental health. PWPs report expertise in helping people with common mental illness to make behavioural changes in the face of mood disturbances and low motivation. PWPs felt confident in offering smoking cessation treatments to patients, but suggested a caseload reduction may be required to deliver smoking cessation support in IAPT. Conclusions: IAPT appears to be a natural environment for smoking cessation treatment. PWPs may need additional training, and a caseload reduction. Integration of smoking cessation treatment into IAPT services should be tested in a pilot and feasibility study.</p

Understanding and Treating Smoking Among Individuals with a Mental Illness

Background and significance Reasons for smoking among individuals living with a mental illness Smoking cessation treatment for individuals living with a mental illnes

Tobacco dependence treatment for special populations: challenges and opportunities

Although smoking rates have declined in most of the countries in the world, there are population groups within these countries whose smoking rates remain significantly higher than the general population. These ‘‘forgotten groups’’ who have not been receiving the needed attention in tobacco control policies and tobacco cessation efforts include people with serious mental illness, substance use disorders, tuberculosis, people living with human immunodeficiency virus (HIV), lesbian-gaybisexual-transgender-queer people, and pregnant women. A number of steps are needed at the national level in countries where these disparities exist, including modifications to national smoking cessation treatment guidelines that address the special needs of these populations, as well as targeted smoking cessation research, since these populations are often not included in clinical trials. Because of the higher smoking prevalence in these populations, as well as their lower smoking cessation treatment success rates than the general population, more resources are needed if we are to reduce health disparities in these vulnerable populations. Additionally, we believe that more effort should be focused on integrating smoking cessation treatment in the specialized care settings frequented by these subpopulations

Healthcare financing systems for increasing the use of tobacco dependence treatment

Background Tobacco smoking is the leading preventable cause of death worldwide, which makes it essential to stimulate smoking cessation. The financial cost of smoking cessation treatment can act as a barrier to those seeking support. We hypothesised that provision of financial assistance for people trying to quit smoking, or reimbursement of their care provide r s, could lead to an increased rate of successful quit attempts. This is an update of the original 2005 review. Objectives The primary objective of this review was to assess the impact of reducing the costs for tobacco smokers or health care providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smoker s making a quit attempt (quitting smoking for at least 24 hours). We also assessed the cost effectiveness of different financial interventions, and analysed the costs per additional quitter, or per quality-adjusted life year (QALY) gained. Search methods We searched the Cochrane Tobacco Addiction Group Specialised Register in September 2016. Selection criteria We considered randomised controlled trials (RCTs), controlled trials and interrupted time series studies involving financial benefit interventions to smokers or the ir healthcare providers, or both

Evidence-Based Smoking Cessation Treatment for Disparate Populations

Overview of this presentation: Describe Research Group and Program of Research among disparate Populations Discuss smoking among persons with substance use and mental illness Present smoking cessation outcomes from evidence-based programs for persons with substance use disorders and mental Illness Conclusion with current and future Project

Evidence-Based Smoking Cessation Treatment for Disparate Populations

Overview of this presentation: Describe Research Group and Program of Research among disparate Populations Discuss smoking among persons with substance use and mental illness Present smoking cessation outcomes from evidence-based programs for persons with substance use disorders and mental Illness Conclusion with current and future Project

Special Ops: Vulnerable Populations and Tobacco Treatment

Reasons for Smoking among individuals with co-morbid substance use (SUD)and/or psychiatric disorders (PD) Smoking cessation treatment for individuals with co-morbid substance use (SUD) and/or psychiatric disorders (PD) Smoking among the Homeless populatio