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1 4/7/217 Interpretation of survey data and opportunities in patient care Prof. Dr. med. T. Raupach, MME University Medical Centre Göttingen University College London Presentation outline 1) Patient-centred approach 2) Student-centred approach 3) Physician-centred approach 4) Research-centred approach 1

2 4/7/217 The patient perspective Physician (n = 77) and patient (n = 675) survey at Göttingen University Medical Centre knowledge on pathophysiology and health consequences of smoking knowledge on effective treatments recollection of counselling The patient perspective Raupach et al. Eur J Cardiovasc Prev Rehabil 211; 18:

3 4/7/217 Lung cancer (8-9%) Pancreatic cancer (2-4%) COPD (7-9%) ENT cancer (6-9%) Physicians (n = 77) Proportion of respondents [%] Smoking-attributable fractions Physician survey (n = 77) Non-smoking patients (n = 433) Proportion of respondents [%] 2 5 Patient survey (n = 433 non-smokers) Smoking patients (n = 223) Proportion of respondents [%] Patient 2 survey (n 2= 223 smokers) 2 5 Raupach et al. Eur J Cardiovasc Prev Rehabil 211; 18: Lung cancer (8-9%) Pancreatic cancer (2-4%) COPD (7-9%) ENT cancer (6-9%) Physicians (n = 77) Proportion of respondents [%] Non-smoking patients (n = 433) Proportion of respondents [%] Smoking patients (n = 223) Proportion of respondents [%] Raupach et al. Eur J Cardiovasc Prev Rehabil 211; 18:

4 4/7/217 The patient perspective Raupach et al. Eur J Cardiovasc Prev Rehabil 211; 18: The patient perspective Physician (n = 77) and patient (n = 675) survey at Göttingen University Medical Centre knowledge on pathophysiology and health consequences of smoking knowledge on effective treatments recollection of counselling: - medical wards: 21.6% - surgical wards: 43.6% 4

5 4/7/217 The physician perspective 99% of physicians felt that smoking status of all patients should be documented at every visit. 94% said that they actually did so. 94% felt that all smokers should be advised to quit, but only 27% actually did so. Raupach et al. Eur J Cardiovasc Prev Rehabil 211; 18: Twardella & Brenner, Eur J Public Health 25; 15:

6 4/7/217 Training in clinical aspects of smoking cessation was particularly neglected, with 6% of PRHOs reporting that they graduated unable to deliver smoking cessation interventions in accordance with national guidelines. Only 17% of PRHOs felt well prepared to deliver advice on using nicotine replacement therapy, and 5% on bupropion. Twardella & Brenner, Eur J Public Health 25; 15: Presentation outline 1) Patient-centred approach 2) Student-centred approach 3) Physician-centred approach 4) Research-centred approach 6

7 4/7/217 The student perspective 26: pilot survey at Göttingen Medical School 36 medical schools 29 interested Kick-off meeting (Göttingen) Mailing of questionnaires Survey in summer 29 students of Years 1-5 were included completed questionnaires were returned to Göttingen descriptive analysis by year of medical education Raupach et al., Nicotine Tob Res 29; 11(1): Medical School Completed Response questionnaires rate (%) Aachen Berlin traditional Berlin reformed Bochum traditional Bochum reformed Participants Bonn Duisburg Essen Düsseldorf Erlangen Nürnberg Frankfurt am Main Göttingen Greifswald Halle Wittenberg Hamburg Heidelberg Jena Kiel Köln Leipzig Lübeck Mainz Marburg München (LMU) München (TU) Münster Regensburg Ulm Witten Herdecke Würzburg Total 19, Sex distribution (f/m): 64.6 / 35.4% pre-clinical/clinical: 47.7 / 52.3% 7

8 4/7/217 % I know the health consequences of Hypertension Diabetes Problem drinking Smoking % % % Proportion of students 8% 6% 4% 2% 8% 6% 4% 2% 8% 6% 4% 2% 8% 6% 4% 2% % % 1 % % % I know how to treat... Hypertension Diabetes Problem drinking Smoking % % % Proportion of students 8% 6% 4% 2% 8% 6% 4% 2% 8% 6% 4% 2% 8% 6% 4% 2% % 1 % % Strobel / Raupach et al. Addiction 212; 7: % Willpower alone Self-help material Acupuncture GP advice % % % % Proportion of students Proportion of students 8% 6% 4% 2% % % 8% 6% 4% 2% % % % Year of education Year of education Year of education Year of education NRT 8% 6% 4% 2% Partial nicotine Antidepressants receptor agonists % % % 8% 6% 4% 2% 8% 6% 4% 2% 8% 6% 4% 2% 8% 6% 4% 2% 8% 6% 4% 2% GCP + NRT Colour key according to scale options very effective not effective % Year of education % Year of education % Year of education % Year of education Raupach et al., under review 8

9 4/7/217 Presentation outline 1) Patient-centred approach 2) Student-centred approach 3) Physician-centred approach 4) Research-centred approach The physician perspective Prospective intervention study involving 123 GP trainees enrolled in 3-year Vocational Training Schemes across England Questionnaire surveys before and after a 3.5-hour smoking cessation training session as well as 3 months later Only 23 recalled having received any teaching on counselling (mostly <2 h), and only 1 has ever had a practical training session. Bobak & Raupach; unpublished data 9

10 4/7/217 The physician perspective Bobak & Raupach; unpublished data Presentation outline 1) Patient-centred approach 2) Student-centred approach 3) Physician-centred approach 4) Research-centred approach

11 4/7/217 A research perspective the most successful method used by most ex-smokers is unassisted cessation. Chapman & MacKenzie, PLoS Med 2; 7(2): e216 A research perspective 2 million smokers 7% 14 million: want to quit % ca. 1/3 5% 6 million: unwilling to quit 7 million: quit attempt 6.9 million: unassisted,: support 2% % continuously abstinent at 6 months 14 11

12 4/7/217 A research perspective Analysis of STS data Inclusion criterion: failed quit attempt in the previous year (n = 9,274) Which method did you use in that quit attempt? 5.8% 15.9%.6% 47.8% Stop Smoking Service Prescription medication OTC medication unassisted Raupach, Fidler Brown et al. & West, BMC Nicotine Public Health Tob Res 211; 213; 11: 15: Conclusions Surveys of hospitalised patients indicate that the delivery of smoking cessation advice on hospital wards is inadequate. Most physicians believe they have not received adequate training to help smokers quit. This assumption is supported by the results of the largest medical student survey in Germany to date. Correct interpretation of survey data requires clear research questions and a sound methodology. Patient, physician and student surveys can help identify areas of potential improvement and inform policies aimed at further optimising the quality of patient care. 12

13 4/7/217 Contact information Prof. Dr. Tobias Raupach, MD, MME Smoking cessation clinic Dept. of Cardiology and Pneumology University Medical Centre Göttingen Phone: