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 [email protected]
www.epshp.fi The Main Goal: Tobacco-Free Finland 2040 -A 10 % decrease in the use of tobacco yearly
3.12.2013 www.epshp.fi 1 Health Services of South Ostrobotnia
Private health care Specialized medical Primary Occupational and services- Central Hospital health care health care occupational health care Unit for the Development of Primary Health Care • 8,500 health care and Health Promotion professionals • 11,000 elective surgeries • Approximately 1,500 smoking patients operated on yearly
3.12.2013 www.epshp.fi 2 Seinäjoki Central Hospital Population of South Ostrobothnia: 198,000
Joint Municipal Authority Kaksineuvoinen Lake Ostrobothnia Cooperative Region Kauhava – Evijärvi – Lappajärvi Alajärvi – Vimpeli – Soini 23, 048 Evijärvi 15, 543
Lapua Health Centre 14 ,698 Kauhava Lappajärvi Vimpeli Seinäjoki Health Centre Seinäjoki – Isokyrö 65, 326 Isokyrö Lapua Alajärvi
Soini Kuortane Ilmajoki Seinäjoki Kurikka
Ähtäri Alavus Teuva Jalasjärvi Kauhajoki Suupohja Municipally Karijoki Owned Company for Joint Municipal Authority for Health Services Primary Health and Social Kuusiokunnat Services Alavus – Kuortane – Ähtäri Kauhajoki – Isojoki – Isojoki 22 ,249 Karijoki – Teuva 23 ,559 JIK Municipally Owned Company for Primary Health and Social Services Jalasjärvi – Ilmajoki – Kurikka 34,324
www.epshp.fi 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 (www.enrokfrioperation.se) • Commitment from senior officers in both primary health care and specialized medical services to start developing the model in Nov 2011.
www.epshp.fi 5 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.
www.epshp.fi 6 3. Training helps staff approach smokers • In the years 2011-2013, 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
www.epshp.fi 7 4. Adverse effects of smoking in South Ostrobothnia: Preventable premature deaths per year, estimate
• Smoking 217 Ennenaikaiset kuolemat • Nutrition 181 250
• Lack of exercise 145 200 • Accidents 101 • Alcohol and drugs 90 150
• Suicides 50 100
50
Anne Pietinalho 0 ti
Filha 2006 semus ähäisyys Tupakoin Itsemurhat Ravit Tapaturmat holi/huumet an v Alko
Liikunn www.epshp.fi 8 What would the yearly consequences be if there were no smokers in South Ostrobothnia?
We could prevent 181–208 premature deaths; −80–107 related to cardiovascular diseases −64 related to lung cancer −37 related to COPD We could save 64 million € per year Anne Pietinalho Filha 2006
www.epshp.fi 9 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;2265-72)
3.12.2013 www.epshp.fi 10 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)
3.12.2013 www.epshp.fi 11 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; 2265-72)
3.12.2013 www.epshp.fi 12 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)
3.12.2013 www.epshp.fi 13 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;96.451 -61) • These interventions are cost-effective (Chest 2009,135:477-83)
3.12.2013 www.epshp.fi 14 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 no2:477-483)
3.12.2013 www.epshp.fi 15 Lung and wound complications
• Smoking cessation at least 4 weeks before surgery: • Lung complications -50% • Wound complications -30% (Can J Anaesth 2011 Dec 21 )
3.12.2013 www.epshp.fi 16 Long-term results of the intervention • Smoke-free surgery for 36% of the patients • A year later, 90 % of these patients were non- smokers (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
3.12.2013 www.epshp.fi 17 7. Smoke-free surgery
• refers the patient for a need for surgery Doctor in primary assessment care/ occupational • recommends smoking cessation counselling health care • informs the nurse of the need for smoking cessation counselling
Nurse in primary health care • invites the patient for individual counselling • the individual counselling lasts 3 months, /occupational health involving 6 times contact care
• The doctor makes the decision to operate • The nurse motivates the smoker to accept Doctor and nurse in individual counselling specialized medical • The nurse gives the patient the contact services information for smoking cessation counselling • The unit that referred the patient is informed by letter of the need for individual counselling
3.12.2013 www.epshp.fi 18 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
3.12.2013 www.epshp.fi 19 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.
3.12.2013 www.epshp.fi 20 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
www.epshp.fi 21 -Thank you
3.12.2013 www.epshp.fi 22