Overview of Tobacco Treatment Provisions at a National Level -- Martin Raw

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Presentation by Martin Raw, UK Centre for Tobacco Control Studies and National Institute of Alcohol and Drug Policies, Brazil, at the Global Bridges Preconference at the 15th World Conference on …

Presentation by Martin Raw, UK Centre for Tobacco Control Studies and National Institute of Alcohol and Drug Policies, Brazil, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.

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  • Low and low-middle income countries under represented
  • Arguably mass media campaigns (and other measures eg. Article 6, 8, 11, 12, 13) a precursor to cessation support. Only 21% have identified a budget for treatment and 20% have an official treatment strategy.
  • 75% of countries have no or very limited specialised treatment services. The real figure is undoubtedly lower.
  • One issue here is having a quitline that is evidence based. If not don’t bother?
  • In reality access to cessation support is very limited, remembering agin that these figures OVERESTIMATE the true figures.
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  • How can brief advice be established throughout the healthcare system if tobacco use is not even recorded in the notes? And if health professionals smoke / use tobacco?
  • Incredibly high rates of GP smoking in some countries.
  • Bearing in mind more responses so far from high and high-middle income countries, these data suggest that fewer than half of Parties have yet implemented the first part of FCTC Article 14 « each Party shall develop and disseminate guidelines based on scientific evidence ». Note by the way not just develop but develop « and disseminate »
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  • Why the 2009/10 surge? COP2 2007 (asked for Sectretariat A14 report) / COP3 2008 (asked for A14 guidelines) / COP4 2010 (A14 guidelines presented and adopted)
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  • 1. Overview of treatment provision at national level Martin Raw UK Centre for Tobacco Control Studies & National Institute of Alcohol and Drug Policies, Brazil Global Bridges workshop, WCTOH, Singapore March 2012
  • 2. Survey of Article 14 implementation This presentation is based on the preliminary results of a survey conducted with colleagues from Nottingham andHarvard Universities, funded by the Society for the Study ofAddiction and the FCA, to whom we are extremely grateful. We are:Asaf Bitton, Ann McNeill, Rachael Murray, Hemba Piné-Abata, Martin Raw, Nancy Rigotti Our posters reporting this work are presented at thisconference, and the survey will be published in a peer reviewscientific journal, and will also serve officially as FCA Article 14 monitoring in a report presented at COP5
  • 3. Interests statementI do not accept funding from the manufacturers of stop smoking medications My funding since 2008 is from:Bloomberg Philanthropies, FCA, Global Bridges, Roswell Park Transdisciplinary Tobacco Use Research Centre, Society for the Study of Addiction, SRNT
  • 4. SampleAll Parties to the FCTC for which we have contacts so far Parties 174 Countries* 176 No contacts yet 22 Total sample so far 154 Responses 69 (45%)* Parties minus EU and UK plus England, N Ireland, Scotland, Wales
  • 5. Sample by region and income level Americas 41% Europe 56% Africa 29% Eastern Mediterranean32% South East Asia 20% Western Pacific 37% High income 33% Upper middle 33% Lower middle 23% Low 10%
  • 6. Some key policy elements
  • 7. Do you have specialised treatment services?
  • 8. Quitlines (n=30)
  • 9. Can tobacco users get help in the following settings? (%)
  • 10. How medications are licensed (%)
  • 11. Three key policiesMandatory recording of tobacco use in 27%medical notesPromote brief advice in existing services like 59%tuberculosis, HIV/AIDS, etcOffer help to healthcare workers to stop 48%
  • 12. Reducing tobacco use in health professionalsTable 3.1: Selected studies of GP smoking prevalenceCountry Method and sample details Published % who smokeBulgaria3 National survey (n=1194) in 8 of 28 regions 2005 44Denmark6 Postal questionnaire with 313 GPs 1993 33 National questionnaire of 1,284 physicians including 370Greece10 GPs 2007 39Italy11 Regional phone interview 2003 28Netherlands12 Postal survey with GPs and other physicians. 1990/93 38Romania14 Survey, details not given, n=1136, p=0.05 2000 43Slovakia4 European postal survey of GPs 2005 49Sweden4 European postal survey of GPs 2005 4
  • 13. Guidelines (n=39)Have national guidelines 57%For whole healthcare system 77%Dissemination strategy 51%Published in peer review journal 26%Government/public support 69%Clear description of writing process 69%COI statements for all authors 41%Pharma industry support 18%
  • 14. Are the guidelines for all healthcare professionals?
  • 15. Some key guideline characteristics
  • 16. Year of guideline publication
  • 17. Do guidelines recommend
  • 18. Percent of guidelines that recommend these medications
  • 19. More key guideline characteristicsStress that HCPs should not use tobacco 69%Formally endorsed by national professional 77%Associations (ten or more 18%)Peer reviewed 74%Formally supported by government 64%Professional associations involved in writing 74%or reviewingInclude cost effectiveness data 41%Reference other countries’ guidelines 69%Based on another countries 46%
  • 20. Other countries’ guidelines referenced
  • 21. Based on other countries’ guidelines
  • 22. Key findings / messages2. All regions in world represented4. Largest sample ever for civil society monitoring (currently 88 countries or 50%)6. These findings will under-estimate provision (because low income regions under-represented in our reponses so far)
  • 23. Key findings / messages1. Under half of the countries in our sample run mass media campaigns promoting cessation3. Only 44% have quitlines5. Only 25% have treatment systems with national coverage7. Another 25% have virtually no treatment provision at all
  • 24. Key findings / messages1. Recording of tobacco use in notes still not mandatory3. Smoking health professionals still an issue5. Few tobacco users can easily get help in any settings
  • 25. Key findings / messages• 57% of countries have national guidelines• Only half have a dissemination strategy• Few have COI statements• A surge in publishing guidelines in 2009/2010
  • 26. In one sentence Cessation support / treatmentis not yet a priority in most countries