The importance of integrating tobacco cessation with the existing healthcare services was emphasized by Professor (Dr) Rama Kant, Head of the Department of Surgery, CSM Medical University, Lucknow and a World Health Organization (WHO) Director General's Awardee (2005). He was speaking at the ongoing 14th World Conference on Tobacco Or Health (WCTOH) in Mumbai. He firmly believes that we can use the existing vast healthcare network of our country in tobacco control, simply by better management and utilization of the existing healthcare staff, at no extra cost. Involvement of health care workers is a major tool in curbing the tobacco epidemic.
Studies have shown that even a brief counseling by health professionals on dangers of smoking and the importance of quitting goes a long way in reducing tobacco consumption. This method is cost effective too and has been successfully tried in some parts of the state of Uttar Pradesh, informed Prof (Dr) Rama Kant. He felt that it was essential for all the primary and community health centres in the rural areas to join hands with the district hospitals/medical institutes in the urban areas to be part of this tobacco control activity.
The health professionals need to have adequate knowledge and a proper attitude in order to put the plan into practice. Proper training (by way of lectures and audio visual programmes) of the doctors, paramedics, nurses and all others involved in patient care is very essential. This should be coupled with a proper attitude. Lack of time is often cited as an excuse. But even a cursory remark by the doctor like – 'do you take tobacco?' may have a tremendous cessation outcome. A study has revealed that smoking cessation interventions during physician visits were associated with increased patient satisfaction. Patients are bound to feel that the doctor cares for them. Even one minute spent with the patient, results in an abstinence rate of 11% which increases to 17.5% if contact time is 3 minutes.
A 'vital signs stamp' for every patient is maintained and updated at every visit. This piece of paper records various parameters like weight, blood pressure etc. of the patient, along with his/her tobacco use status. Once the status of the patient's tobacco usage is known, the next vital step is to advise every tobacco user in a clear and personalized manner to quit.
If the person is willing to quit then a personalized quit plan is developed or else the patient is referred to a cessation clinic. If the person is unwilling to quit, then motivational intervention should be provided. In either case, follow up action is essential.
The Slip of Out-Patient's Department (SOPD), which is made for each patient visiting the hospital, can carry an anti-tobacco message and information about its use being prohibited in the hospital. All baseline workers including 'anganwadi' workers, village 'panchayats' and other such opportunities where programmes can benefit from synergizing, have to be part of the national tobacco control campaign.
“Strong and repeated information dissemination to the public about hazards of tobacco, legal issues involved and availability of cessation facilities will go a long way in making the programme a success. With persistence and perseverance, we are bound to succeed” said Prof Kant.
Shobha Shukla, Citizen News Service (CNS)
(The author serves as content Editor of Citizen News Service (CNS). Email: [email protected], website: www.citizen-news.org)