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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

  • Background
  • Preparation
  • Launch
  • Challenges

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

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
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
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

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 +





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
  • 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
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