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WorkshopRole of healthcare systems and providers in changing tobacco  dependence treatment and         tobacco policy     ...
15th World Conference on Tobacco or Health                    Singapore March 19th 2012Company              Type of relati...
Latin America       • South of Rio Bravo       •Area 21,069,500 km²       (7,880,000 sq mi),       •2010 pop 590 million  ...
Smoking in Latin America• 1/3 of population smoke• Highest prevalence   •Males: Cuba and Chile   •Females: Argentina and C...
Smoking in Latin America   FCTC (except Argentina, Cuba, Dominican Republic, El   Salvador, Haiti, and St. Vincent and Gre...
Smoking in Latin America  •Art 11 Warning and images at least 30% of surface  (Bolivia, Brasil, Chile, Colombia, Honduras,...
Informal Survey among TDT           (early in 2011)                   Brasil     Chile     México    Argentina   Uruguay  ...
Treatment affordability in Latin             America Mac      Drug/Marlboro and Drug/Big                    Full treatment...
Smoking Prevalence among Doctors                                   9
Doctors and tobacco in LA < 30% had ever been trainned <10% recalled 5A strategy <15% recognize NRT as effective Smoki...
Intervention Works!* Minervini MC y col .RAMR 2006(3):100-105                                                   11
LA Global Bridges: aims for 2011• Aim 1: to develop a large network of health care providers  and organizations to promote...
LA Global Bridges:   Metrics 2011                                    13
GLOBAL BRIDGES LA: Metrics      Date                       Course          Attendees   Hours  April 28, 2011             P...
GLOBAL BRIDGES Latin America      Evaluation scores Maximum                  20 point Maximum score achieved         20 ...
GLOBAL BRIDGES Latin America            Evaluation scores               Percentage of questions scored correctly        Co...
GLOBAL BRIDGES Latin America       Evaluation scores          Percentage of questions scored correctly      Concept       ...
LA Global Bridges team LA Regional Director    Gustavo Zabert- gzabert@gmail.com LA Regional secretary    Vicki Baldi vi...
Faculty Puebla 2011                      19
“Every breath we draw (without tobacco smoke), every step we take, every meal we eat, is an attempt to fight off death”   ...
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Role of Health Care Systems and Providers in Changing Tobacco Dependence Treatment and Policy in Latin America -- Gustavo Zabert, M.D.

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Presentation by Gustavo Zabert, M.D., a pulmonologist and the Global Bridges regional director for the Latin American region, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.

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Role of Health Care Systems and Providers in Changing Tobacco Dependence Treatment and Policy in Latin America -- Gustavo Zabert, M.D.

  1. 1. WorkshopRole of healthcare systems and providers in changing tobacco dependence treatment and tobacco policy Latin America 2011 1
  2. 2. 15th World Conference on Tobacco or Health Singapore March 19th 2012Company Type of relationship Content AreaPfizer Principal investigator for Investigator iniciated research in MOTIVARE001 research protocol motivation to quitAstra National Coordinator (independent COPD research project in ArgentinaZeneca contractor) for PUMA research projectNovartis Principal investigator for a COPD Cross sectional study to explored prevalence´s protocol in Argentina COPD in Argentina I never had any relationship with tobacco industries Gustavo Zabert Disclosure of COI 2
  3. 3. Latin America • South of Rio Bravo •Area 21,069,500 km² (7,880,000 sq mi), •2010 pop 590 million •Languages : Spanish, Portuguese, Quechua, Maya, Guaraní, Aymara, Nahuatl, and others. •Combined GDP at 5.16 trillion  (US 6.27 trillion) •33 countries (CA-Ca-SA) 3
  4. 4. Smoking in Latin America• 1/3 of population smoke• Highest prevalence •Males: Cuba and Chile •Females: Argentina and Chile •Teens: Argentina and Chile •Physicians Cuba, Argentina and Chile•Tobacco related mortality 265.000 death peryear (underestimated) 4
  5. 5. Smoking in Latin America FCTC (except Argentina, Cuba, Dominican Republic, El Salvador, Haiti, and St. Vincent and Grenadines) • Art 6 Panama and Venezuela • Art 8 Smoke free envitoment •Natl smoke free law: Uruguay (2006), Panamá (2008), Guatemala (2009), Colombia (2009), Perú (2010), Trinidad y Tobago (2010), Honduras (2010), Barbados (2010), Venezuela (2011) •State smoke free law: 7 in Brazil and 9 in Argentina •After IAHF report Paraguay (2011), Argentina (2011) y Ecuador (2011) had launched Natl smoke free law.Allemani, L., et al., Convenio Marco para el Control del Tabaco: desafíos paraAmérica Latina y el Caribe. Reporte de la Sociedad Civil. 2010, IAHF 5
  6. 6. Smoking in Latin America •Art 11 Warning and images at least 30% of surface (Bolivia, Brasil, Chile, Colombia, Honduras, México, Nicaragua Panamá, Paraguay, Perú, Uruguay y Venezuela) •Art 14 7 Guidelines, CTS less than 10 points (top Brazil) •Art 15 Smuggling CARICOM 50%, Bolivia 46%, Brazil 35%., (Paraguay export 90% of production but only 5% legally)Allemani, L., et al., Convenio Marco para el Control del Tabaco: desafíos paraAmérica Latina y el Caribe. Reporte de la Sociedad Civil. 2010, IAHF 6
  7. 7. Informal Survey among TDT (early in 2011) Brasil Chile México Argentina Uruguay Perú Paraguay Si Si Si Si Si Si SiNat´l Guidelines 2008 2003 2008 2005† 2009 2010 2010Person Si Si Si Si Si No Siresponsible Parcial Parcial Parcial Parcial Parcial Score de tratamiento (máximo 10 puntos)Treatment score 9 6 6 7 8 5 3Nat´l Quitline 2 1 1 2 1 1 0Nat´l treatment 6 4 4 4 5 4 3SystemReimbursement 1 1 1 1 2 0 0of treatment.† Update process in 2011 7
  8. 8. Treatment affordability in Latin America Mac Drug/Marlboro and Drug/Big Full treatment in U$ - OTC prices Marlboro Big Mac NRT Mexico 21 Mexico 28 NRT Argentina 157 Paraguay 183 Bupropion Uruguay 10 Brazil 6 Nortriptiline Brazil 11 Brazil 6,6 Varenicline Argentina 175 Paraguay 200 Varenicline Uruguay 50 Chile 48Drug/ Marlboro higher index favors smoking (not quitting)Drug/ Big Mac lower index Tt is more affordable (quitting)Informal Survey among TDT (early in 2011) 8
  9. 9. Smoking Prevalence among Doctors 9
  10. 10. Doctors and tobacco in LA < 30% had ever been trainned <10% recalled 5A strategy <15% recognize NRT as effective Smoking behavior bias their attitude Medical students showed similar figures Subset population showed Worst scenario (psychologists, Surgeons, GO) Better scenario (pulmonologists, GP) Zabert G Los Medicos y el Tabaco en MEDEF II: Tiempo de Intervenir Ed Polemos 10
  11. 11. Intervention Works!* Minervini MC y col .RAMR 2006(3):100-105 11
  12. 12. LA Global Bridges: aims for 2011• Aim 1: to develop a large network of health care providers and organizations to promote tobacco dependence treatment and fully implementation of the Article 14th of FCTC.• Aim 2: to survey the smoking cessation training programs in Latin America as well as the organization that provide support and/or endorse the curricula.• Aim3: To develop a training strategy for HCP and train at least • 150 HCP in a basic level • 20 HCP in an advance level to act as faculty for the basic level for the following years 12
  13. 13. LA Global Bridges: Metrics 2011 13
  14. 14. GLOBAL BRIDGES LA: Metrics Date Course Attendees Hours April 28, 2011 Puebla (Mexico) 70 8 May 7, 2011 Neuquén (Argentina) 15 8 March 31, 2011 Neuquén (Argentina) 42 12 Julio 1, 2011 Asuncion (Paraguay) 86 8 August 4, 2011 Cordoba (Argentina) 62 4 August 8, 2011 Parana (Argentina) 39 8September 7, 2011 San José (Costa Rica) 43 8October 15, 2011 Lima (Peru) 17 4October 25, 2011 Quito (Ecuador) 36 12 Total 406 14
  15. 15. GLOBAL BRIDGES Latin America Evaluation scores Maximum 20 point Maximum score achieved 20 point Mean score for post training 14, 9 points (range 11- 20) Mean score for pre training 11, 3 points (range 4-18) Difference 3, 6 points (Δ 32% 15
  16. 16. GLOBAL BRIDGES Latin America Evaluation scores Percentage of questions scored correctly Concept Pre Post Change ORP1 Epidemiology 29,41% 63,95% 117,44% 2,17 (1,73-2,73)P2 FCTC 26,92% 46,28% 71,92% 1,71 (1,33-2,106)P3 Epidemiology 41,58% 60,34% 45,12% 1,45 (1,20-1,75)P4 CO Biomarker 58,91% 92,88% 57,66% 1,57 (1,39-1,77)P5 Smoking behav 88,94% 94,28% 6,00% 1,06 (1,01-1,12=P6 Initiation during teen 81,07% 87,84% 8,35% 1,08 (1,00-1,17)P7 Neurobiology reward 50,49% 83,45% 65,28% 1,65 (1,42-1,91)P8 Why brief intervention 43,63% 53,72% 23,13% 1,23 (1,02-1,34)P9 Prochaska 62,75% 84,46% 34,60% 1,34 (1,19-1,51)P10 FNDT 48,73% 71,86% 47,47% 1,47 (1,25-1,73) 16
  17. 17. GLOBAL BRIDGES Latin America Evaluation scores Percentage of questions scored correctly Concept Pre Post Change ORP11 Cognitive and drugs treat 94,03% 94,94% 0,97% 0,99 (0,95-1,04)P12 NRT 52,00% 49,65% -4,52% 0,98 (0,88-1,20)P13 Craving 57,29% 80,20% 39,99% 1,22(1,59-1,65)P14 Non nicotine Drugs 27,08% 44,78% 65,36% 1,65 (1,26-2,15)P15 Physician Role 77,39% 88,59% 14,47% 1,14(1,05-1,24)P16 Relaps and success 83,17% 87,59% 5,31% 1,05(0,99-1,13)P17 Antidepressant drugs 67,88% 75,27% 10,89% 1,19(0,98-1,24)P18 Adverse effects Varenicline 22,87% 86,17% 276,78% 3,74(2,88-4,01)P19 Laser for smk cessation 81,05% 91,17% 12,49% 1,12(1,04-1,21)P20 NRT in CV pts 60,82% 77,66% 27,69% 1,27(1,12-1,45) Average 57,80% 75,75% 46,32% 17
  18. 18. LA Global Bridges team LA Regional Director Gustavo Zabert- gzabert@gmail.com LA Regional secretary Vicki Baldi victoriabaldi@gmail.com LA Host Organization Interamerican Heart Foundation (IAHF) Beatriz Champagne beatriz.champagne@interamericanheart.org Javier Valenzuela Javier.valenzuela@interamericanheart.org Faculty team Carlos Jimenez Ruiz (Spain) Raul Sansores Martinez (Mexico) Erika Urdapilleta (Mexico) Eduardo Bianco (Uruguay) Daniel Buljuvacich (Argentina) Rogelio Pendino (Argentina) Edgardo Sandoya (Uruguay) Victor San Martin (Paraguay) Roberto Castro Cordoba (Costa Rica) Fernando Müller (Argentina) Justino Regalado Pineda (Mexico) Andres Mainini (Argentina) Luis D Larrateguy (Argentina) 18
  19. 19. Faculty Puebla 2011 19
  20. 20. “Every breath we draw (without tobacco smoke), every step we take, every meal we eat, is an attempt to fight off death” Arthur Schopenhauer(free version) 20

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