Establishing and running a new quitline in hungary
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Establishing and running a new Quitline in Hungary. Peter Vajer Robert Urban Barna Boze Ferenc Tamás János Szabó. Content. Background Preparation Launch Challenges. World Tobacco Atlas.

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Establishing and running a new quitline in hungary

Establishing and running a new Quitline in Hungary

Peter Vajer

Robert Urban

Barna Boze

Ferenc Tamás

János Szabó


Content

Content

  • Background

  • Preparation

  • Launch

  • Challenges


Establishing and running a new quitline in hungary

World Tobacco Atlas


Establishing and running a new quitline in hungary

Tombor et al. Epidemiology of smoking in Hungary – a national representative study Orvosi Hetilap 151. évfolyam, 9. szám ■ 330–337


Establishing and running a new quitline in hungary

HFA database


Establishing and running a new quitline in hungary

HFA database


Establishing and running a new quitline in hungary

HFA database


Tobacco control in hungary 1990 2010

Tobacco control in Hungary 1990-2010

  • Taxes are raised regularly and above the rate of inflation (still much cheaper than in Western countries)

  • Ban of direct and indirect marketing (June 2008)

  • 11th country in the world ratifying FCTC

  • “Decade of Health - National Public Health Program”


Problem list

Problem list

  • Prevalence of smoking is stable in the past 10 years

  • High smoking related mortality and morbidity

  • Lack of good and comprehensive tobacco control programs

  • No reimbursement neither for cessation activity nor for pharmacotherapy


Establishing and running a new quitline in hungary

Pfizer Global Health Fund + Pfizer Hungary

Grant


Smoking cessation services

Smoking cessation “services”

  • Network of pulmonologists

  • Family physicians/GPs

  • No quit centers


Ghp grant summary

GHP grant - summary

  • Establishing a smoking cessation center in Budapest

  • Training smoking cessation specialists

  • Providing proactive and reactive telephone; group and individual counseling

  • Capacity building (research, services, networking)


Main goals

Main goals

  • To implement intense behavioural smoking cessation programs

  • To provide a referral system for health care providers

  • To build up collaboration between the center and primary care providers

  • To decrease smoking related mortality and morbidity


Target population

Target population

  • Smokers who are willing to quit

  • Daily smokers in Hungary: 2.290.000 adults

  • Daily smokers in Budapest: 390.000 adults

  • Daily smokers in Pest county: 207.000 adults


Implementation plan

Implementation plan

Year 1.

  • Need assessment of the target population

  • Building up the operation of the Tobacco Cessation Centre

  • Intense training for the counselors

  • Training the primary care physicians (minimal intervention, referral system)


Implementation plan1

Implementation plan

Year 2-3.

  • Running and actuation of the service

  • Monitoring and evaluation:

    • clients’ satisfaction

    • primary care providers’ satisfaction

    • cost-benefit analysis


Outcomes of the program

Outcomes of the program


Need assessment

Need assessment

  • Quantitative and qualitative research/need assessment has been carried out in order to optimize the services:

    • Quantitative research involved representative sample of 510 smokers from Budapest and Pest county; and 144 family physicians),

  • Qualitative research involved focus groups (3 FGs with smokers, 2 FGs with family physicians, and 1 FG with nurses/assistants), and 15 individual interviews with family physicians


Survey among smokers

survey among smokers

Note: *: only in Budapest, and **: Budapest and Pest county


2009 preparation survey among family physicians

2009 – preparationsurvey among family physicians


Development of treatment protocols

Development of treatment protocols

  • Desk research

  • International collaboration related to best practices is built up. Participation in the 14th WCTOH helped to build up international partnerships with other quitlines.

  • A visit was made in the center of QUIT (London).

  • Created a treatment protocol for individual, group and telephone counseling.


Development of the information communication system

Development of the information/communication system

  • Specification was defined for the programmer.

  • The software for the call-center and CRM has been pretested before purchase.

  • IT management was established coordinating the system building

  • Webpage was constructed


Smoking cessation specialists training content areas

Smoking Cessation Specialists’ training – content areas

  • Smoking and health

  • Epidemiology of smoking including international statistics and Hungarian data

  • Development of smoking and nicotine addiction

  • Levels of smoking cessation supports: clinical and public health perspectives

  • Diagnostic interview and factors that influence smoking cessation success

  • Motivational interviewing in smoking cessation support


Smoking cessation specialists training content areas1

Smoking Cessation Specialists’ training – content areas

  • Cognitive-behavioral therapy for smoking cessation

  • Pharmacotherapy in smoking cessation support

  • Treatment of withdrawal symptoms and relapse prevention counseling

  • Long-term barriers of quitting: stress, weight concerns etc.

  • Features and practices of telephone counseling

  • Group processes - how to facilitate smoking cessation groups

  • Special issues: adolescents, pregnant women, psychiatric population


Reactive and proactive service

Reactive and proactive service

Reactive +

Proactive

intense

Reactive

only

15. Sept. 2009.

1. January 2010.


Proactive counseling

Proactive counseling

  • Planned way of quitting smoking

  • Different protocolls: 5-8 consultation

  • 6 consultation:

    • Every call has its own objective:

      • Motivational support

      • Preparation for the quit date

      • How to choose the quit date

      • Dealing with withdrawal symptoms

      • Relapse prevention

  • Long term follow up (6 months)


Info hub function

Info-hub function

Guiding people to local resources

  • Pulmonologists

  • Family physicians

  • Psychologists/psychiatrists

  • Other helplines

  • Other information centres, handouts, websites


Website

Website

  • Seems to be effective, cheap, can be integrated with regular counseling.

  • Our website offers:

    • Chatroom

    • “ask our expert”

    • Self help materials

    • Registration for proactive counseling


Milestones

Milestones


Reaching clients by the original plan

Reaching clients by the original plan

  • The doctor/nurse informs and refers the client

    • Ask

    • Advise

    • Assess

    • Refer

  • The ways of referring:

    • E-mail

    • Telephone

    • Fax

    • Post


  • First results in cessation counseling

    First results in cessation counseling

    • 488 registered on the website,

      • 124 involved in telephone counseling,

      • 30 involved in group counseling

    • 36 referred (most of them from the “mobile screening”), 22 has started the cessation program


    Reaching clients now

    Reaching clients – now!

    • Website, facebook,

    • “mobile screening – Health for a lifetime”

    • Contacts with NGO’s of chronic patients

    • European Network Smoke-free Hospitals

    • Health centers

    • Posters

    • Midwifes


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