Establishing and running a new Quitline in Hungary

1. Establishing and running a new Quitline in Hungary Peter Vajer Robert Urban Barna Boze Ferenc Tamás János Szabó

2. Content • Background • Preparation • Launch • Challenges

3. World Tobacco Atlas

4. Tombor et al. Epidemiology of smoking in Hungary – a national representative study Orvosi Hetilap 151. évfolyam, 9. szám ■ 330–337

5. HFA database

6. HFA database

7. HFA database

8. Tobacco control in Hungary 1990-2010 • Taxes are raised regularly and above the rate of inflation (still much cheaper than in Western countries) • Ban of direct and indirect marketing (June 2008) • 11th country in the world ratifying FCTC • “Decade of Health - National Public Health Program”

10. Problem list • Prevalence of smoking is stable in the past 10 years • High smoking related mortality and morbidity • Lack of good and comprehensive tobacco control programs • No reimbursement neither for cessation activity nor for pharmacotherapy

11. Pfizer Global Health Fund + Pfizer Hungary Grant

12. Smoking cessation “services” • Network of pulmonologists • Family physicians/GPs • No quit centers

13. GHP grant - summary • Establishing a smoking cessation center in Budapest • Training smoking cessation specialists • Providing proactive and reactive telephone; group and individual counseling • Capacity building (research, services, networking)

14. Main goals • To implement intense behavioural smoking cessation programs • To provide a referral system for health care providers • To build up collaboration between the center and primary care providers • To decrease smoking related mortality and morbidity

15. Target population • Smokers who are willing to quit • Daily smokers in Hungary: 2.290.000 adults • Daily smokers in Budapest: 390.000 adults • Daily smokers in Pest county: 207.000 adults

16. Implementation plan Year 1. • Need assessment of the target population • Building up the operation of the Tobacco Cessation Centre • Intense training for the counselors • Training the primary care physicians (minimal intervention, referral system)

17. Implementation plan Year 2-3. • Running and actuation of the service • Monitoring and evaluation: • clients’ satisfaction • primary care providers’ satisfaction • cost-benefit analysis

18. Outcomes of the program

19. Need assessment • Quantitative and qualitative research/need assessment has been carried out in order to optimize the services: • Quantitative research involved representative sample of 510 smokers from Budapest and Pest county; and 144 family physicians), • Qualitative research involved focus groups (3 FGs with smokers, 2 FGs with family physicians, and 1 FG with nurses/assistants), and 15 individual interviews with family physicians

20. survey among smokers Note: *: only in Budapest, and **: Budapest and Pest county

21. 2009 – preparationsurvey among family physicians

22. Development of treatment protocols • Desk research • International collaboration related to best practices is built up. Participation in the 14th WCTOH helped to build up international partnerships with other quitlines. • A visit was made in the center of QUIT (London). • Created a treatment protocol for individual, group and telephone counseling.

26. Development of the information/communication system • Specification was defined for the programmer. • The software for the call-center and CRM has been pretested before purchase. • IT management was established coordinating the system building • Webpage was constructed

27. Smoking Cessation Specialists’ training – content areas • Smoking and health • Epidemiology of smoking including international statistics and Hungarian data • Development of smoking and nicotine addiction • Levels of smoking cessation supports: clinical and public health perspectives • Diagnostic interview and factors that influence smoking cessation success • Motivational interviewing in smoking cessation support

28. Smoking Cessation Specialists’ training – content areas • Cognitive-behavioral therapy for smoking cessation • Pharmacotherapy in smoking cessation support • Treatment of withdrawal symptoms and relapse prevention counseling • Long-term barriers of quitting: stress, weight concerns etc. • Features and practices of telephone counseling • Group processes - how to facilitate smoking cessation groups • Special issues: adolescents, pregnant women, psychiatric population

31. Reactive and proactive service Reactive + Proactive intense Reactive only 15. Sept. 2009. 1. January 2010.

35. Proactive counseling • Planned way of quitting smoking • Different protocolls: 5-8 consultation • 6 consultation: • Every call has its own objective: • Motivational support • Preparation for the quit date • How to choose the quit date • Dealing with withdrawal symptoms • Relapse prevention • Long term follow up (6 months)

36. Info-hub function Guiding people to local resources • Pulmonologists • Family physicians • Psychologists/psychiatrists • Other helplines • Other information centres, handouts, websites

37. Website • Seems to be effective, cheap, can be integrated with regular counseling. • Our website offers: • Chatroom • “ask our expert” • Self help materials • Registration for proactive counseling

39. Milestones

40. Reaching clients by the original plan • The doctor/nurse informs and refers the client • Ask • Advise • Assess • Refer • The ways of referring: • E-mail • Telephone • Fax • Post

41. First results in cessation counseling • 488 registered on the website, • 124 involved in telephone counseling, • 30 involved in group counseling • 36 referred (most of them from the “mobile screening”), 22 has started the cessation program

42. Reaching clients – now! • Website, facebook, • “mobile screening – Health for a lifetime” • Contacts with NGO’s of chronic patients • European Network Smoke-free Hospitals • Health centers • Posters • Midwifes