dr. hudoyo - innovative partnerships presentation

8/6/2019 Dr. Hudoyo - Innovative Partnerships Presentation

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SMOKING CESSATION CLINICSMOKING CESSATION CLINIC

PERSAHABATAN HOSPITAL JAKARTAPERSAHABATAN HOSPITAL JAKARTA

( A partnership model)( A partnership model)

SMOKING CESSATION TEAM, PERSAHABATAN HOSPITAL


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BACKGROUND


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Diseases caused by smoking

WHO report on the global epidemic of tobacco, 2008


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Diseases caused by secondhand smoke

WHO report on the global epidemic of tobacco, 2008


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Tobacco use is a risk factor for six of the eight leading

causes of death in the world

WHO Report on the Global Tobacco Epidemic, 2008

Chronic diseaseChronic disease-- NCDNCD


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SMOKINGSMOKING PREVENTABLE caused ofPREVENTABLE caused of

disease and mortalitydisease and mortality 11

6

3 mortality caused in US smoking

#1 LUNG CANCER#1 LUNG CANCER

#2 ISCHEMIC LUNG DISEASE#2 ISCHEMIC LUNG DISEASE

#3 CHRONIC OBSTRUCTIVE PULMONARY DISEASE#3 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Cancer

Lung Leukemia

Laryngeal (AML, ALL, CLL)2-4Oral cavity/pharynx Esophageal

Stomach Pancreatic

Kidney Bladder

Cervical

Cardiovascular

Ischemic heart disease

Stroke Vascular dementia5

Peripheral vascular disease6

Abdominal aortic aneurysm

Respiratory

COPD

PneumoniaPoor asthma control

Reproductive

Low-birth weight

Pregnancy complications

Reduced fertility

Sudden Infant Death Syndrome

Other

Adverse surgical outcomes/wound

healing

Hip fractures

Low-bone density

Cataract

Peptic ulcer disease

1. Surgeon Generals Report.The Health Consequences of Smoking. 2004; 2. Sandler DP et al.J Natl Cancer Inst.1993;85:1994-2003; 3. Crane MM et al.Cancer Epidemiol Biomarkers Prev. 1996;5:639-644; 4. Miligi L et al.Am J Ind Med.

1999;36(1):60-69; 5. Roman GC.Cerebrovasc Dis. 2005;20(Suppl 2):91-100; 6. Willigendael EM et al.J Vasc Surg. 2004;40:1158-1165. 6


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Estimated mortality from tobacco use in Australia in 200405


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COPD prevalence by periode of survey publication

Eur Respir J 2007; 30: 993- 1013


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COPD Cases in Persahabatan Hospital 2000 - 2008

0

00

1000

1 00

2000

2 00

2000 2001 2002 2003 200 200 2006 200 2008

Year

Totalcas

es

per

year


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0

100

200

300

400

500

600

700

800

900

1000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

tal

ases

er

ear

Lung cancer Cases in Persahabatan Hospital2000

-2009


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Mortality prevented or postponedMortality prevented or postponed

QuittingQuitting

SmokingSmoking

7235

24680

4710

0

5,

000

10,000

15,000

20,000

25,000

30,000

35,000

Mort lity

reventedor

ost oned (N)

Cholesterol

Reduction

Blood ressure

Reduction

1. Unal Bet al.BMJ. 2005;331:614


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SMOKING CESSATIONSMOKING CESSATION

IS ONE OF MANY WAYIS ONE OF MANY WAYTO PREVENTTO PREVENT

CHRONIC DISEASECHRONIC DISEASE


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SMOKING CESSATION CLINICSMOKING CESSATION CLINIC

PERSAHABATAN HOSPITALPERSAHABATAN HOSPITAL

JAKARTAJAKARTA


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Levels of smoking cessation interventionLevels of smoking cessation intervention

InterventionIntervention

levellevel

SmokerSmoker InterventionIntervention

typetype

Health stafHealth staf

involvedinvolved

FirstFirst

SecondSecond

Healthy smokerHealthy smoker

Healthy smoker,Healthy smoker,

difficult casesdifficult cases

Unhealthy smokerUnhealthy smoker

MinimalMinimal

IntensiveIntensive

MultimodalityMultimodality

Primary carePrimary care

SpecialistSpecialist

(Hospital base)(Hospital base)

SMOKING CESSATION CLINIC AT PERSAHABATAN HOSPITAL


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70 % smoker want to quit but 70 % smoker want to quit but

Only 5%-10% can doit unassisted

1/3 of them try to stop smoking1/3 of them try to stop smoking

each yeareach year


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multidimentionalmultidimentionalwhy difficult ?why difficult ?

Physiology

- icotine addiction

-Withdrawal effect

Psychological

-Behavioral

-Environment


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SMOKING CESSATIONSMOKING CESSATION

THERAPYTHERAPY

Non pharmacology :Non pharmacology :

Psychological therapy and behaviourPsychological therapy and behaviour

therapytherapyCounselingCounseling

-- ShortShort

-- MultiMulti -- session supportsession support

-- GroupGroup Family supportFamily support

PharmacologyPharmacology


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PharmacotherapyPharmacotherapyPharmacotherapyPharmacotherapy

Nicotine replacement therapy (NRT)1

Long acting1-3

Patch

Short acting1-3 Gum

Inhaler

Nasal spray

Sublingual tablets/lozenges

Antidepressant

Bupropion SR4

Varenicline

19

Strenght of evidence = A


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History of smoking cessation clinicHistory of smoking cessation clinic

Persahabatan HospitalPersahabatan Hospital

In 1990In 1990

First time smoking cessationclinic at PersahabatanHospital was declared

Declared by some ofpulmonologist doctor

Place at Asthma Building Concept :

- Counseling

- Without pharmacotherapy


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That clinic vacuum aproximately 18 years

There is no patient

Because drugs medication for smoking

cessation is no available Counselling alone is not effective in patient

perspective


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Okt 2008Smoking CessationTeam atPersahabatan

Hospital weredeclared

November, 7th 2008

re-openingsmokingcessation clinic


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New conceptNew concept

Multimodality

approach

Combined nonpharmacotherapy

and

pharmacotherapy

Continuous

programme


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MOTIVATION (SUPPORT)MOTIVATION (SUPPORT)

ADDICTION & WITHDRAWAL MANAGEMENTADDICTION & WITHDRAWAL MANAGEMENT

FAMILY SUPPORTFAMILY SUPPORT

QUITTERQUITTER

OUR CLINIC STRATEGYOUR CLINIC STRATEGY

FOLLOW UPFOLLOW UP


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Place :Griya Puspa Building,

2nd floor

Time open :

Monday - Friday

09.00 15.00


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StaffStaff

Major

- General Practicioner(2)

- Pulmonologist (3)

- Pshyciatric specialist (1)

- Medical Rehabilitation specialist (1)

Support :

Cardiologist, Internist, radiologist, clinical pathologist,occupational, nutritionist, et.al


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OUR PROGRAMMEOUR PROGRAMME

1. Promotion and prevention programme

- Education, meeting, symposium, training (personal,

group, institution or company)

- Addiction nicotine test

2. Early detection of disease related smoking

- Screening programme for abnormality or disease

correlated with smoking- Consultation with related specialist doctors

3. Smoking cessation programme


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OUR ACTIVITIESOUR ACTIVITIES

Health education

Talkshow

Health effect ofsmoking


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Health education about smoking cessation

Outpatient

clinic


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School

Health education about health effect of

smoking


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smoking

In population


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In company


smoking


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Smoking cessation programmeSmoking cessation programme

Outpatient clinic

Inpatient


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FacilitiesFacilities

Counseling for smoking cessation

- Short counseling

- Pshyciatric counseling

Pharmacotherapy

Behaviour therapy Respiratory rehabilitaion and exercise programme

Withdrawal effect management

Hypnotherapy

Weight gain programme

Measurement of urine nicotine Lung function test

Measurement of CO exhalation

Screening programme for disease related smoking


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SMOKING CESSATION PROGRAMMESMOKING CESSATION PROGRAMME

AT PERSAHABATAN HOSPITALAT PERSAHABATAN HOSPITAL

Initial evaluationInitial evaluation

Short counselingShort counseling

Pshyciatric counselingPshyciatric counseling

Drugs (varenicline)Drugs (varenicline)

11STST

MonthMonth

22NDND MonthMonth

33rdrd MonthMonth

*In selected patient

Telephone counselingTelephone counseling

Behaviour therapy *, Exercise programme *Behaviour therapy *, Exercise programme *

Short counselingShort counselingPshyciatric counselingPshyciatric counseling

Drugs (varenicline)Drugs (varenicline)

Hypnotherapy *Hypnotherapy *

Group counselingGroup counseling Konseling singkatKonseling singkat

Konsultasi psikologisKonsultasi psikologis

Obat (varenicline)Obat (varenicline)Konseling kelompokKonseling kelompok


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Referral system (external)

ClinicClinic

Other healthOther health

facilitiesfacilities

Primary CarePrimary Care

Other hospitalOther hospital

Smoking CessationSmoking Cessation

ClinicClinicPersahabatanPersahabatan

HospitalHospital

CompanyCompany

doctordoctor

PrivatePrivatedoctordoctor


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Lung clinicLung clinic

Asthma ClinicAsthma Clinic

Heart ClinicHeart Clinic

Internal medicineInternal medicine

clinicclinic

Other specialistOther specialist

clinicclinic

Smoking CessationSmoking Cessation

ClinicClinic

Lung wardLung ward

Internal medicineInternal medicine

wardward

Heart wardHeart ward

Other wardOther ward

GP clinicGP clinic

Referral system (internal)


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Symposium

Smoking Cessation

Programme

Workshop

workshop smokingcessation

SYMPOSIUM/TRAININGSYMPOSIUM/TRAINING


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Colaboration with PT Pfizer Indonesia to give

workshop smoking cessation programme for :

- Primary care doctor at Bekasi

- Pimary care doctor at Jakarta- Doctor in company or institution likely Pertamina,

BPKP

- Primary care and private doctor at East Java

- Private doctor at Jakarta- Medical student


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Collaboration with PT Pfizer Indonesia in

Quitter Are Champions (QAC) programme

2009-2010

Free smoking cessation programme 18 participant

100% succes to cessation in 3 month


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Collaboration with PT Pfizer Indonesia in

Quitter Are Champions (QAC) programme in :

- PEMDA Bekasi

- PT Pertamina


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Total patient in 2009Total patient in 2009

Type Total patient Method

Outpatient 26 Counseling +

pharmacotherapy

Inpatient 38 Counseling

Total 64


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pharmacotherapy


Total 52


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pharmacotherapy


Total 32


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THANKYOU

dr. hudoyo - innovative partnerships presentation

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