November 26, 2002 Volume 38 Issue
43
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CHEST PHYSICIANS UPDATE
In San Diego more than 4,000
pulmonologists,
thoracic surgeons, cardiologists, critical care and primary
care
physicians attended CHEST 2002, the international scientific
meeting of the American College of Chest Physicians. The
gathering had a great sense of urgency in the wake of last
year's 9/11 terrorist attacks. Chest physicians are now
expected
to play a greater role in planning, implementing and
following
up in the event of natural or manmade disasters, while
traditional battles, like educating the medical community
and
patients about the dangers of smoking, remain a priority.
Medical Post freelance contributor John Schieszer was there
and
files the reports here. |
Too few doctors help their patients
quit
smoking
�
Not all physicians are following guidelines that include
ask,
advise, arrange followup
By John Schieszer
SAN DIEGO � Some physicians may need to get off their butts
when
it comes to smoking. It turns out many of them are not bothering
to
actively assist their patients in trying to stop smoking because
they either don't have the time or they simply feel it is not an
achievable goal.
���Those are the latest findings from researchers
at North Shore
University Hospital in Manhasset, N.Y., presented here at CHEST
2002, the annual scientific meeting of the American College of
Chest
Physicians.
���The New York researchers conducted a study in
which they found
that young smokers are not receiving advice from physicians to
quit
smoking and most of the study patients said they did not
perceive
they were getting active assistance from their physician in the
quitting process.
���"A lot of people reported that they had
seen a physician within
the last year and they were not asked if they smoked," said
nurse
practitioner Lynn Villano, who is a tobacco cessation specialist
at
the hospital.
���She is the co-author of a study that looked at
health-care
providers and whether they were complying with tobacco-control
guidelines. The study looked at 276 people (174 females, 102
males).
The mean age was 49 and the average "pack years" was
42.7 for males
and 33.9 for females.
���Most of the patients had previously attempted
to quit. Villano
said 40% of the participants had tried to quit once before and
another 50% had tried to quit more than once.
���In the study, patients received nicotine
replacement therapy,
bupropion therapy and six one-hour weekly sessions that included
psychosocial support, behaviour modification, guided imagery and
positive reinforcement. Guidance via telephone and e-mail also
was
provided.
���"We used a lot of different therapies and
our program was very
successful. We had an overall quit rate of men and women of
about
53%, which is more than double the average of other similar
programs," said Villano.
���Villano said the unusually high success rate
might be due, in
part, to the fact the smoking intervention program they used
included grief counselling.
���"These people feel the cigarettes are
their best friends and they
are losing a lifelong friend," said Villano. She added that
the
program also incorporated a lot of humour and the counsellors
were
careful never to mention cancer or try to scare the participants
with gory pictures.
���Interestingly, the study found that many
physicians did not
comply with the Agency for Health Care Policy and Research's
Tobacco
Control Guidelines.
���"The guidelines are called the 'five As.'
You are supposed to
ask, advise, arrange for followup and assess the smoking of your
patient," said Villano. However, she said that is not
happening a
great deal of the time and it especially did not occur among the
younger participants in their study.
���"It is not on the problem list. It is more
in the realm of
preventive medicine and that needs to change," said Dr.
Frank Leone,
who is the director of the Comprehensive Centre for Tobacco
Research
and Treatment at Thomas Jefferson University in Philadelphia.
"Only
70% of smokers say in a given year their physician asked them
whether they smoked."
���Villano said approximately 90% of the
participants in the study
said they had at least talked to their physicians about smoking.
But
she said data from the study showed most patients did not
perceive
active assistance from their physicians in the quitting process.
���She said either physicians are unaware of the
existence of the
guidelines or they do not perceive smoking cessation as an
achievable goal in patient management.
�
�
For more stories from the CHEST PHYSICIANS UPDATE, click on the
links below.
Increase use of spirometry to catch more COPD
E-nose gives head start to diagnosing pneumonia
Too few doctors help their patients quit smoking
Try steroids to help COPD, burn patients gain weight
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