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Progress in the development, monitoring, and implementation of tobacco dependence treatment around the world 13 March, 2013 Boston, MA. Mayo Clinic receives funding from Pfizer that supports a portion of my effort Clinical trial research using varenicline

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  1. Progress in the development, monitoring, and implementation of tobacco dependence treatment around the world 13 March, 2013 Boston, MA

  2. Mayo Clinic receives funding from Pfizer that supports a portion of my effort • Clinical trial research using varenicline • Global Bridges (Pfizer Medical Education Group) • No Pharma consultation or advisory panels • No tobacco industry funds Disclosures

  3. Martin Raw-- Conclusions • Relatively few countries have quitlines • Their provision also is strongly related to income level • Those that exist are run broadly in line with the evidence base • Provision of specialist treatment facilities strongly related to income level • As is the rated affordability of medications

  4. One sentence summary of our results?Offering support to tobacco users who wish to stop is not yet a priority for the majority of countries in the world “The reality is that in most of the world tobacco users cannot easily get help.”

  5. Martin Raw- Recommendations • Record tobacco use in all clinical notes • Address tobacco use among HCW’s • Integrate brief advice into all healthcare systems • Encourage the licensing of affordable medications

  6. Harry Lando- Implementation of Article 14 • Growing burden of chronic disease for which tobacco use is a major risk factor • There is a large gap between guideline acceptance and effective implementation • HCW’s need to take a lead in tobacco control • Model the behavior- quit smoking • Provide brief intervention to there patients

  7. Tunisian Project • Champion in the government with resources • Intervene with HCW’s to help them quit • Begin with broad implementation of brief behavioral support • Then demonstrate the gap between treatment needs of those who can easily quit tobacco and those who will need more support • Intervention resources to bridge the gap

  8. Ron Borland-- Some thoughts • The cessation population may change over time • Assistance only reaches a minority • Those who need it may not want it early on • Role of specialist clinics??? • Roles for Quitlines • Rx access patchy • Access for poor??? • Potential of internet • Knowledgeable health professionals

  9. Treatobacco.net dissemination of information Progress in the development, monitoring, and implementation of tobacco dependence treatment around the world Total users during 2010: 34,588 (-8.26%) Total users during 2011: 35,109 (+1.51%) Total users during 2012: 53,653(+52.82%) January 2012, +42% February 2012, +35%

  10. Treat tobacco.net • Growing use by TTS and other professionals • Powerful engine for dissemination of • State-of-the-art evidence • Best practices • Treatment guidelines • Can TTN become an impetus for the development of guidelines in all FCTC countries?

  11. What we heard today • Tobacco users have limited access to evidence based treatment in most countries • Prevalence of smoking among HCW’s remains alarmingly high • There is a large gap between acceptance of tobacco control best practices and implementation/execution at a country level

  12. Global Bridges • Leverage the broad reach and motivation of physicians to provide tobacco dependence treatment and advocacy for tobacco control • Networking, training, supporting • Important efforts in multiple regions after only two full years of work

  13. Specialized clinics Healthcare systems intervention (record smoking status, brief advice) Population-level intervention (e.g., quit-line, mobile devices) Policy/Legislation/TaxationP

  14. What Next? • Make the case for the role of treatment in comprehensive tobacco control • Government/legislature • Health ministries • Professional societies • Funders • Build capacity among HCW’s to provide effective treatment

  15. What Next? • Provide treatment to HCW’s who use tobacco • Is there “low-hanging fruit”? • Implement uniform recording of smoking status • Low cost treatment (brief intervention) and broader reach approaches (quit-lines, internet) • Capacity building among HCW’s • Innovatively introduce higher cost treatments • Efficacious medications • Specialized treatment

  16. Avoiding the potholes • “Circular firing squad” • Excluding stakeholders • All health professionals • All medical specialties • Organizations not in health care • Failure to recognize changing demographics and populations

  17. THANK YOU!

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