Issue 46 / 5 December 2011

IF smokers are treated like other patients with chronic, relapsing conditions it can improve their odds of quitting over the long term, according to a US study.

Researchers set out to test whether a chronic disease management approach could boost long-term abstinence from tobacco. They found it was about 75% more effective than traditional approaches involving discrete episodes of care.

The study, published in the Archives of Internal Medicine, compared the results of a 1-year telephone-based program with those of a standard treatment offered over 8 weeks. (1)

Before the management programs started, all participants received identical evidence-based cessation treatment, with behavioural and drug components. Both groups had five counselling calls over 4 weeks, and nicotine replacement therapy was available by mail.

Following this, one group received only two additional counselling calls, while the other group continued to receive counselling and nicotine replacement therapy for a further 48 weeks.

“The chronic nature of drug dependence, including nicotine, has been compared with other medical disorders, such as diabetes, hypertension, and asthma”, the authors wrote.

However, they said current models of treatment for smokers did not incorporate the principles of chronic disease management, such as continuity of care, stepped care improvement of symptoms and self-management.

Most quit-smoking programs lasted 6-12 weeks, and only 10% of smokers quit over the long term, with most relapsing within 3 months of treatment, the authors said.

The study found that at 18 months, 30.2% of those on the 1-year program had reported 6 months of abstinence from smoking compared with 23.5% in the 8-week program.

The authors said the efficacy of the treatment should be tested in the varied settings in which tobacco treatment is delivered, including quit-smoking lines.

Dr Flora Tzelepis, from the Centre for Health Research and Psycho-oncology at the University of Newcastle, NSW, agreed further testing was needed.

“I think the concept is great and more studies should be looking at testing stepped or continued care in different settings including quit lines”, she said.

Dr Tzelepis said a lot of people did relapse when treatment stopped, so it was interesting that continued support seemed to increase success over the longer term. The treatment program also offered smokers more than one chance to quit during the program.

Professor Simon Chapman, a professor in public health at the University of Sydney, said this type of intervention was seldom taken up on a large enough scale to affect smoking levels across whole populations.

“We know that only about 3% of smokers are even willing to pick up the phone and call the Quitline, despite it being on every [cigarette] pack, in every retail outlet and on every anti-smoking ad”, he said.

The best way to tackle the problem was through public policies that affected the price and public sentiment.

“One of most important interventions is for doctors to opportunistically raise the topic with patients and encourage them to quit”, he said.

– Amanda Bryan

1. Arch Intern Med 2011; 171: 1894-1900

Posted 5 December 2011

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