Commentary: Health education for chronic diseases in primary care
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"contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M Torrecilla García, M Barrueco, JA Maderuelo, C Jiménez Ruiz, MD Plaza Martín, MA Hernández Mezquita" "autores" => array:6 [ 0 => array:2 [ "Iniciales" => "M" "apellidos" => "Torrecilla García" ] 1 => array:2 [ "Iniciales" => "M" "apellidos" => "Barrueco" ] 2 => array:2 [ "Iniciales" => "JA" "apellidos" => "Maderuelo" ] 3 => array:2 [ "Iniciales" => "C" "apellidos" => "Jiménez Ruiz" ] 4 => array:2 [ "Iniciales" => "MD" "apellidos" => "Plaza Martín" ] 5 => array:2 [ "Iniciales" => "MA" "apellidos" => "Hernández Mezquita" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:8 [ "pii" => "13036735" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => 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"etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Data have shown that cigarette smoking is the most widespread preventable public health problem in Spain in terms of attributable morbidity and mortality. Unfortunately, society­and perhaps many health professionals­are not yet fully aware of this fact. In general, smokers do not consider themselves to be ill (60% report enjoying good perceived health), although technically many should be considered objectively to be nicotine-dependent. These reasons justify a brief, discreet initial intervention in most smokers.</p><p class="elsevierStylePara"><img src="27v30n04-13036732tab01.gif"></img></p><p class="elsevierStylePara">The concept of minimal intervention is unclear because this type of intervention can vary in intensity. In other words, certain types of minimal</p><p class="elsevierStylePara">intervention may need considerably more time than what is usually available in primary care to achieve the goals of the most widely used smoking cessation guidelines.</p><p class="elsevierStylePara">The WHO and the American Consensus favor the term «brief (or very brief) intervention» to designate brief counseling, and this term should be preferred to «minimal intervention». The excellent study by Torrecilla García and colleagues in this issue of Atención Primaria emphasizes the idea that both brief (minimal) intervention and pharmacological treatment offered in primary care can be as effective as specialized intervention if correct methods are used.</p><p class="elsevierStylePara">It is now known that ex-smokers constitute 15% of the population in Spain. This figure indicates that health professionals are encountering smokers who are increasingly unwilling to quit, ie, those who have never tried or those who have failed repeatedly. In the foreseeable future the remaining active smokers are likely to be those with greater levels of dependence, who require increasingly intensive treatment and pharmacological support with bupropion-based nicotine replacement therapy.<span class="elsevierStyleSup">1</span> However, the high prevalence of smoking in Spain suggests that there is an enormous amount of work yet to be done at all available levels of clinical intervention.</p><p class="elsevierStylePara">In fact, most smokers can be considered «dissonant» (ie, they do not feel comfortable with their condition as smokers). It is currently accepted that 70% of all smokers would like to quit.<span class="elsevierStyleSup">2</span> This does not mean that most smokers are willing and ready to stop, but that their intention in the middle term is to try to quit in the long run. In Spain it is estimated that at any given time, only 7% of all smokers in the general population would like to quit within the next 4 weeks, although the figure is higher than 12% for persons older than 45 years, and may be even higher in the population who seek medical attention.<span class="elsevierStyleSup">3</span> Each year 40% of all smokers try to quit, although most of them fail.<span class="elsevierStyleSup">2</span> Nevertheless, more than half of all smokers who quit do so on their own, without help from health professionals or available treatments now recognized to be highly effective.<span class="elsevierStyleSup">2,4</span> The minimum annual success rate for those who quit on their own is 1%, but if we consider attempts to quit by those who try over a period of several years, the figure rises to 7%. However, with specific, professional help the mean success rate increases to 15%-30% when modern psychological and pharmacological treatments are used.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Data for the Spanish population indicate that at any given time there are at least 800 000 smokers willing to try to quit. Such a large volume of subjects can only be managed with the participation of the primary care service.<span class="elsevierStyleSup">4</span> The WHO has established that treatment for nicotine dependence should include pharmacological and behavioral intervention (alone or in combination) that can range from brief counseling to specialized intervention with drugs aimed at reducing nicotine dependence in smokers and in the general population. In general, the full spectrum of interventions is effective.</p><p class="elsevierStylePara">There is reasonable evidence that with time, persons who quit smoking consume fewer health resources, and this should encourage managers to concentrate resources on actions aimed at smoking cessation.<span class="elsevierStyleSup">5</span> Smoking is a clear paradigm of a cross-sectional health problem, and care should be organized with a view to patients´ interests and needs. Support services should be staffed by professionals trained in smoking cessation who work full-time, or during a specified number of hours per week, exclusively with smokers.<span class="elsevierStyleSup">2,6</span> Although certain levels of intervention may be more relevant for certain sectors, all professional collectives should be familiar with and implement, when necessary, the full spectrum of effective treatments. The approach to smoking cessation cannot be compartmentalized, nor should different levels of intervention be considered to represent a vertical, closed or hierarchic health care structure.</p><p class="elsevierStylePara">Some questions that need to be raised with regard to the future of care for smoking cessation are: What can we do to increase the use of brief interventions by primary care practitioners? Is it possible at this time to add intensive or advanced intervention to the family doctor´s usual duties? If minimal intervention is not being used, can we expect more extensive interventions to be used?</p><p class="elsevierStylePara">The experience of a few professionals in Spain cannot be extrapolated to the entire primary care system. There are problems arising from the lack of time (with 5 min per patient, prevention and health promotion cannot effectively be integrated into the family doctor´s every-day consulting activities); there are problems with skills (medical schools do not train physicians in smoking cessation interventions); but above all, there are problems of attitude. Too many doctors and nurses smoke, and the problem does not appear to receive the priority it deserves. Difficulties are magnified, opportunities minimized. This situation needs to be reversed with structural reform, increased training and motivation, the promotion of smoke-free health centers, and a social environment more favorable to the regulation of smoking. The road ahead is long, complicated, and difficult, but in the long run the public health benefits will make traveling this road worth the effort.</p>" "pdfFichero" => "27v30n04a13036732pdf001.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "tbl1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v30n04-13036732tab01.gif" "imagenAlto" => 395 "imagenAncho" => 333 "imagenTamanyo" => 14600 ] ] ] ] ] ] 1 => array:5 [ "identificador" => "tbl2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers. 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| 2019 April | 13 | 16 | 29 |
| 2019 March | 9 | 4 | 13 |
| 2019 February | 12 | 10 | 22 |
| 2019 January | 8 | 9 | 17 |
| 2018 December | 11 | 7 | 18 |
| 2018 November | 6 | 7 | 13 |
| 2018 October | 14 | 8 | 22 |
| 2018 September | 4 | 4 | 8 |
| 2018 August | 4 | 1 | 5 |
| 2018 July | 5 | 1 | 6 |
| 2018 June | 6 | 0 | 6 |
| 2018 May | 1 | 2 | 3 |
| 2018 April | 1 | 0 | 1 |
| 2018 March | 9 | 0 | 9 |
| 2018 February | 1 | 0 | 1 |
| 2018 January | 8 | 1 | 9 |
| 2017 December | 5 | 0 | 5 |
| 2017 November | 7 | 2 | 9 |
| 2017 October | 7 | 0 | 7 |
| 2017 September | 6 | 1 | 7 |
| 2017 August | 5 | 0 | 5 |
| 2017 July | 8 | 1 | 9 |
| 2017 June | 3 | 1 | 4 |
| 2017 May | 14 | 3 | 17 |
| 2017 April | 10 | 1 | 11 |
| 2017 March | 10 | 1 | 11 |
| 2017 February | 5 | 0 | 5 |
| 2017 January | 4 | 0 | 4 |
| 2016 December | 5 | 4 | 9 |
| 2016 November | 15 | 0 | 15 |
| 2016 October | 31 | 2 | 33 |
| 2016 September | 13 | 1 | 14 |
| 2016 August | 22 | 1 | 23 |
| 2016 July | 8 | 1 | 9 |
| 2016 June | 22 | 12 | 34 |
| 2016 May | 13 | 3 | 16 |
| 2016 April | 14 | 3 | 17 |
| 2016 March | 9 | 6 | 15 |
| 2016 February | 12 | 3 | 15 |
| 2016 January | 10 | 4 | 14 |
| 2015 December | 14 | 5 | 19 |
| 2015 November | 10 | 4 | 14 |
| 2015 October | 21 | 2 | 23 |
| 2015 September | 21 | 1 | 22 |
| 2015 August | 5 | 2 | 7 |
| 2015 July | 6 | 3 | 9 |
| 2015 June | 1 | 1 | 2 |
| 2015 May | 2 | 2 | 4 |
| 2015 April | 4 | 6 | 10 |
| 2015 March | 8 | 3 | 11 |
| 2015 February | 8 | 1 | 9 |
| 2015 January | 16 | 1 | 17 |
| 2014 December | 23 | 2 | 25 |
| 2014 November | 10 | 0 | 10 |
| 2014 October | 28 | 2 | 30 |
| 2014 September | 21 | 0 | 21 |
| 2014 August | 13 | 2 | 15 |
| 2014 July | 20 | 1 | 21 |
| 2014 June | 22 | 2 | 24 |
| 2014 May | 13 | 2 | 15 |
| 2014 April | 9 | 0 | 9 |
| 2014 March | 6 | 0 | 6 |
| 2014 February | 10 | 2 | 12 |
| 2014 January | 12 | 0 | 12 |
| 2013 December | 9 | 1 | 10 |
| 2013 November | 6 | 3 | 9 |
| 2013 October | 19 | 3 | 22 |
| 2013 September | 12 | 2 | 14 |
| 2013 August | 7 | 1 | 8 |
| 2013 July | 12 | 0 | 12 |
| 2002 September | 265 | 0 | 265 |
Show all
