Preoperative Smoking Cessation Counselling in the Hospital District of South Ostrobothnia

Transcription

1 Preoperative Smoking Cessation Counselling in the Hospital District of South Ostrobothnia Ms Reetta-Maija Luhta, Co-ordinator of Smoking Cessation Services Co-ordinator of the Finnish Smoke-Free Hospital Network, Hospital District of South Ostrobothia,Seinäjoki, Finland

2 The Main Goal: Tobacco-Free Finland A 10 % decrease in the use of tobacco yearly

3 Health Services of South Ostrobotnia Specialized medical services- Central Hospital Primary health care Occupational health care Private health care and occupational health care Unit for the Development of Primary Health Care and Health Promotion 8,500 health care professionals 11,000 elective surgeries Approximately 1,500 smoking patients operated on yearly

4 Seinäjoki Central Hospital Ähtäri Hospital

5 Population of South Ostrobothnia: 198,000 Seinäjoki Health Centre Seinäjoki Isokyrö 65, 326 Joint Municipal Authority Kaksineuvoinen Kauhava Evijärvi Lappajärvi 23, 048 Lapua Health Centre 14,698 Kauhava Isokyrö Lapua Evijärvi Lappajärvi Vimpeli Alajärvi Lake Ostrobothnia Cooperative Region Alajärvi Vimpeli Soini 15, 543 Ilmajoki Seinäjoki Kuortane Soini Kurikka Teuva Alavus Ähtäri Jalasjärvi SuupohjaMunicipally Owned Company for Primary Health and Social Services Kauhajoki Isojoki Karijoki Teuva 23,559 Karijoki Isojoki Kauhajoki Joint MunicipalAuthorityfor Health Services Kuusiokunnat Alavus Kuortane Ähtäri 22,249 JIK MunicipallyOwnedCompany for PrimaryHealth and Social Services Jalasjärvi Ilmajoki Kurikka 34,324

6 1.Initiative for smoke-free surgery The Medical Director of South Ostrobothnia Hospital District was the first in Finland to suggest an initiative for smoke-free surgery in Oct 2011 (Consultation with the Senior Medical Officer of the Operative Services) Aim: Faster recovery, resulting in lower expenditure The model has been extensively tested in Sweden and Denmark ( Commitment from senior officers in both primary health care and specialized medical services to start developing the model in Nov

7 2. Planning the model for Smoke-Free Surgery The model was planned during the year 2012 in collaboration between representatives from specialized medical services, health centre and occupational health care Existing material was partly used in planning the model and material kit Teams were set up in seven health centres to plan the implementation of the smoke-free surgery project. 6

8 3. Training helps staff approach smokers In the years , eleven regional smoking cessation courses (1+½ day)were arranged for staff Total number of participants: 330 In addition, 31 training sessions (1,5 hour) were arranged in hospitals and health centres Number of participants: 380 Smoking cessation material is now included in electronic patient records 7

9 4. Adverse effects of smoking in South Ostrobothnia: Preventable premature deaths per year, estimate Smoking 217 Nutrition 181 Lack of exercise 145 Accidents 101 Alcohol and drugs 90 Suicides Ennenaikaiset kuolemat 50 Anne Pietinalho Filha Tupakointi Ravitsemus Liikunnan vähäisyys Tapaturmat Alkoholi/huumet Itsemurhat 8

10 What would the yearly consequences be if there were no smokers in South Ostrobothnia? We could prevent premature deaths; related to cardiovascular diseases 64 related to lung cancer 37 related to COPD We could save 64 million per year Anne Pietinalho Filha

11 5. Is it possible to affect people s lifestyle? Counselling by a nurse increased smoking cessation by 28%, doctor s order by 66% (17% of the participants quit smoking) (Cochrane Database Syst Rev 2008 Apr 16; (2)) Intervention techniques tailored for patients undergoing a sensitive period bring better results (Duodecim 2011;127; )

12 Health promotion approaches Health promotion should be embedded in the processes so that it takes place systematically Making use of the authority role of specialized medical services and of the sensitive period in the patient s care Can we afford to ignore the contribution specialized medical services could make to health promotion? (Lääkärilehti 45/2011; 3451)

13 Health counselling Patients must have a chance to evaluate the benefits of quitting without judgmental staff attitudes Permanent self-motivated change can be achieved if doctors support patient autonomy Even small-scale action can lead to major results among people at risk of getting ill (Duodecim 2011; 127; )

14 6.Does smoking jeopardize the medical benefits of surgery? Sympathicotonia => reduced oxygen supply Effect on blood coagulation system Vulnerability to infections Collagen synthesis can be affected Pulmonary problems (Suom Lääkäril 2006; 61:3203-8)

15 Any evidence-based research on the benefits? Most critical risks: plastic and foot surgery Smoking cessation intervention will reduce the risk of complications by half (Br J Surg 2009; ) These interventions are cost-effective (Chest 2009,135:477-83)

16 Prosthetic surgery Preoperative (6-8 weeks) smoking cessation Complications decreased by 52%=>18% Wound complications 31%=>5% Cardiovascular complications 10%=>0% Second operation 15%=>4% (Lancet 2002;359:114-7) Average savings resulting from reduced number of hospital days 313 /patient (Chest 2009; 135 no2: )

17 Lung and wound complications Smoking cessation at least 4 weeks before surgery: Lung complications -50% Wound complications -30% (Can J Anaesth 2011 Dec 21)

18 Long-term results of the intervention Smoke-free surgery for 36% of the patients A year later, 90 % of these patients were nonsmokers (Anesthesia 2009 Mar; 64(3):259-65) We must, however, remember that it is humane to look for a balance between medical evidence and imperfection of life Mikael Leppilahti, Senior Medical Officer

19 7. Smoke-free surgery Doctor in primary care/ occupational health care Nurse in primary health care /occupational health care Doctor and nurse in specialized medical services refers the patient for a need for surgery assessment recommends smoking cessation counselling informs the nurse of the need for smoking cessation counselling invites the patient for individual counselling the individual counselling lasts 3 months, involving 6 times contact The doctor makes the decision to operate The nurse motivates the smoker to accept individual counselling The nurse gives the patient the contact information for smoking cessation counselling The unit that referred the patient is informed by letter of the need for individual counselling

20 As many smoking cessation counsellors as possible: Patients, whose employers have extensive occupational health contracts including medical care, will receive smoking cessation counselling from their own occupational health nurses Other patients are referred to health centre nurses or adult s clinic public health nurses for smoking cessation counselling

21 Future smoking cessation support Smoke-free surgeries are just the spearhead of the development; later all smoking patients will be offered smoking cessation counselling in primary and occupational health care and in specialized medical services

22 Key to Success Initiative by management Planning together High staff training coverage The role of the smoking cessation counsellor in consultation Satisfied patients involved in care decisions 21

23 -Thank you