Ärzte Zeitung online, 22.11.2008

More Smokers Stay Abstinent with Medical Support

Smoking cessation courses in groups cost no more per week than a few packs of cigarettes. Doctors being trained as course instructors at the Medica.

 More Smokers Stay Abstinent with Medical Support

The cessation programme consists of a six-week group training. Photo: ami

By Ursula Armstrong

With public buildings and public places increasingly becoming nicotine-free zones, and smoking prohibited in most restaurants and pubs, a growing number of people want to quit smoking. This situation offers doctors a good opportunity to offer their patients smoking cessation courses. However, since these courses fall into the category of "individual healthcare services" (IGeL) smokers have to pay for them out of their own pockets. At the MEDICA in Düsseldorf doctors can learn how to conduct anti-smoking courses. What's more, doctors who successfully complete the training seminar at the MEDICA - the world's largest medical trade fair with parallel medical congress - can obtain a Course Instructor Certificate.

Smoking is definitely out. Doctors can take advantage of the present anti-smoking climate to address the health dangers of smoking. When talking to smokers in their practices, however, doctors should avoid a patronizing tone, stresses Dr. Wolfgang Grebe, an internist in Frankenberg. Many smokers already feel persecuted by militant non-smokers and keep on smoking out of sheer recalcitrance.

However, smokers who want to quit should seek assistance since only two to four percent of smokers who try to "go it alone" manage to kick the habit. In the group of smokers who ask for professional assistance, in contrast, success rates are as high as 40 percent. Support from doctors has proved to be especially effective. "An in-depth discussion with a doctor alone can increase the percentage of patients who manage to remain abstinent for one year by six percent," says Grebe. The internist offers stop-smoking courses as "individual healthcare services" (IGeL) in his practice. "Afterwards, up to 50 percent of the participants manage to stay smoke-free for at least one year," he reports. At the MEDICA Grebe will present his successful model and hold a seminar showing doctors how to conduct anti-smoking courses. Grebe's smoking cessation programme consists of a six-week group training with one 60-minute session per week. At the first course meeting the participants try to identify situations in which they typically reach for a cigarette. After that Grebe uses the quit-day method, which he has found to be most successful. His experience has been that "cutting back or keeping cigarettes stashed away somewhere simply doesn't work" and in fact leads to a high relapse rate. For this reason, each course participant starts by setting a quit date on which he or she will stop smoking. This can be a special occasion such as the smoker's birthday. In most cases, however, it is the third course meeting. After the quit date cigarettes are strictly taboo.

Preventing relapses is an important topic in the course. "We first visualize what is going to happen in the next few days," explains Grebe. Some people gain weight when they stop smoking; some become irritable while others suffer mainly from sleep disorders. Grebe has practical tips for members of all three groups.

People who tend to gain weight, for example, may find it helpful to prepare healthy snacks in the morning such as raw carrots or bell pepper strips with a yoghurt dip. The snacks combat the sensation of hunger and give the smoker something to chew on. These people should also keep a supply of chewing gum in their pockets, he says. For those who feel especially nervous after they stop smoking Grebe's advice is to get up half an hour earlier to avoid feeling rushed in the morning. People who used to smoke mainly in their cars are advised by the internist to borrow a car from a non-smoker for this period - or even to buy a new car." Afterwards, they really notice just how bad their old car smelled!" he laughs.

Medication can be supportive

Grebe initially tries to help smokers break the habit without medication. If this proves difficult, he employs varenicline (Champix®) or nicotine substitution products such as patches and chewing gum. However, in many cases this is not even necessary, he reports. Of the 12 smokers who signed up for his most recent stop-smoking course, eight managed to quit solely on the basis of his support and the tips and tricks he supplied. Three participants with bad memories of previous smoking cessation courses required tablets. The 12th participant suffered from orthostatic problems. This patient was given nicotine patches with good effect.

Between 30 and 40 smokers sign up for each smoking cessation course in Grebe's practice. However, the maximum group size is 12 participants. For each group training session he charges 15 euros (No. 20 in the Doctor's Fee Schedule (GOÄ), 2.14 x the basic rate). Each participant thus pays 90 euros for six course meetings. Grebe's experience has been that the statutory healthcare insurance schemes are willing to reimburse a large part of the fee for the group training against proof of participation, provided that the course instructor holds a certificate qualifying him to conduct smoking cessation courses.

Doctors have the opportunity to obtain this certificate at the MEDICA; however, only doctors who are themselves non-smokers are eligible. "Doctors who have stopped smoking with the quit-day method themselves are particularly authentic as course instructors, of course!" says Grebe. Attendance is limited to 40 physicians. Grebe explains why: "If there are more people in the group, the course is no longer a seminar."


More Smokers Stay Abstinent ...

"Raucherberatung für Ärzte"
In German
Samstag, 22. 11. 2008,
14.30 bis 17.30 Uhr,
CCD-Pavillon Raum 17
Leitung: Dr. Wolfgang Grebe,

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