1. MINIMAL INTERVENTION STRATEGY QUITTING SMOKING MIS Wim Willems HOVUmc

2. Smoking kills

3. Cause of deathPercentage caused by smoking Lungcancer % Asthma / emfysema % Coronary heart disease % Stroke % Total %

4. Smoking kills Cause of deathPercentage caused by smoking Lungcancer82 % Asthma / emfysema % Coronary heart disease % Stroke % Total %

5. Smoking kills Cause of deathPercentage caused by smoking Lungcancer82 % Asthma / emfysema68 % Coronary heart disease % Stroke % Total %

6. Smoking kills Cause of deathPercentage caused by smoking Lungcancer82 % Asthma / emfysema68 % Coronary heart disease32 % Stroke % Total %

7. Smoking kills Cause of deathPercentage caused by smoking Lungcancer82 % Asthma / emfysema68 % Coronary heart disease32 % Stroke42 % Total %

8. Smoking kills Cause of deathPercentage caused by smoking Lungcancer82 % Asthma / emfysema68 % Coronary heart disease32 % Stroke42 % Total49,7 %

9. Quitting smoking is cost effective Costs per year of life gained Treatment of high cholesterol in diabetics €...... Treatment of high blood pressure €...... Advice to quit smoking + nicotine replacement therapy €......

10. Quitting smoking is cost effective Costs per year of life gained Treatment of high cholesterol in diabetics € 14520,-- Treatment of high blood pressure €...... Advice to quit smoking + nicotine replacement therapy €......

11. Quitting smoking is cost effective Costs per year of life gained Treatment of high cholesterol in diabetics € 14520,-- Treatment of high blood pressure € 4540,-- Advice to quit smoking + nicotine replacement therapy €......

12. Quitting smoking is cost effective Costs per year of life gained Treatment of high cholesterol in diabetics € 14520,-- Treatment of high blood pressure € 4540,-- Advice to quit smoking + nicotine replacement therapy € 430,--

13. Negative cognitions of GP’s

14. I cure, prevention is not my business I don’t have the time, I am too busy already It’s energy lost, smokers just don’t quit I don’t where to begin and how to do the follow up It’s too difficult, it’s almost psychotherapy Patients don’t want me to confront them with their smoking habits I smoke myself, how do I make a credible story?

15. GP’s effectiveness Method% success 1 yr. net result % success 1 yr. cumulative result Spontaneous MIS (no NRT) MIS + NRT

16. GP’s effectiveness Method% success 1 yr. net result % success 1 yr. cumulative result Spontaneous2,5 % MIS (no NRT) MIS + NRT

17. GP’s effectiveness Method% success 1 yr. net result % success 1 yr. cumulative result Spontaneous2,5 % MIS (no NRT) 5 %7,5 % MIS + NRT

18. GP’s effectiveness Method% success 1 yr. net result % success 1 yr. cumulative result Spontaneous2,5 % MIS (no NRT) 5 %7,5 % MIS + NRT2,5 %10 %

19. MIS Motivation dependent --> tailor-made Short and systematic Delegation of tasks possible Respects autonomy of patient Non dependent on patient’s complaints Patient is active, doctor follows

20. MIS

21. MIS 1 Happy smoker

22. Motivation? Have you ever considered to quit smoking? Do you want to quit in the near future? 1 yes --> Motivation + 2 no --> Motivation -, general advice to quit, information

23. MIS 2 Considers to quit 1. Smoking profile (nicotine dependency) do you smoke 10 cigarettes a day or more? do you smoke your first cigarette within 30 minutes of waking up? 2. Increase motivation (“I want to quit”) advantages of quitting disadvantages of continuing challenge excuses 3. Barriers (“I can quit”) increases self-confidence

24. MIS 3 Decision fix a date within 1 to 2 weeks convenient informative material, NRT, other medication new appointment shortly after quitting

25. MIS 4 Action

26. experiences thus far congratulations / praise relapse prevention motivation? barriers? at least one new appointment after 2-3 months

27. MIS 5 Relapse Too bad, but nothing is lost Positive affirmation (you tried, you succeeded) Causes? Motivation for a new try? Barriers? New appointment?

28. www.gpsupport.nl