Systems approach in tobacco dependence treatment through hospitals - a one year study from Jaipur, India

Abstract

Background Systems approach in tobacco dependence treatment is missing in India despite low quit rates. The attitude of the users and healthcare professionals is a major barrier. The objectives of this study were to determine whether: (1) tobacco dependence treatment can be delivered in a hospital setting; and, (2) its results will provide higher quit rate vs. no treatment. Methods This one year study (2013) undertaken at a tertiary-care multi-specialty hospital at Jaipur, India identified currently tobacco using patients. Those willing were assisted to quit through brief intervention (BI). Those desirous or referred for intensive treatment (II) were treated in Tobacco Cessation Clinic (TCC). All were followed-up telephonically after 1 week, 1 month, 6 months and in April 2014. The responders were categorized as Successful quit, Failed to quit and Relapsed. Results This study enrolled 1264 patients out of 19657 (6.43%). In 43.4% patients (549/1264) who consented for the treatment, while overall quit rate was 26.1% (CI: 23.8- 28.6), in the BI group it was 54.2% (CI: 49.7- 59.0) and in the II group it was 84.9% (CI: 78.4- 92.0) vs. zero quit rate in untreated. The use of pharmacotherapy improved overall quit rate by 14.6% (71.1 [63.0, 78.1] in those treated with pharmacotherapy vs. 56.5 [51.7, 61.2] who were counseled only); the quit rate was significantly higher in smokers and dual users vs. users of smokeless tobacco (SLT users). The quit rates did not differ for the type of tobacco user except in smokeless tobacco (SLT) users in first six months of follow-up. Conclusions This study achieved both its objectives of being able to deliver tobacco dependence treatment in a hospital setting; and, achieving higher quit rates. Hence, a replication of this model is recommended to establish the envisioned utility in the country as well as other low- and middle- income countries.

Keywords

• WCTOH