[Approach and management of tobacco quitting process of the smoker patient by 149 residents in a university hospital in Tours]

INTRODUCTION

How do residents, specialists or general practitioners advise patients who are smokers when they are admitted to hospital? Do they assess their smoking status? How much do they know about smoking cessation? Do they know the tests essential to allow an effective approach to smokers?

METHODS

One hundred and forty-nine residents were approached over a nine-month period by three pharmacy students. The questionnaire addressed the assessment of smokers and the possible management of their quitting process: the average time devoted to tobacco cessation, knowledge of "brief smoking cessation advice", assessment of nicotine addiction and motivation to quit as well as detection of withdrawal symptoms, knowledge of the list of nicotine substitutes prescribed by the Tours CHRU, and referral of smokers to a smoking cessation specialist.

RESULTS

One hundred and thirty-four (90%) residents out of the 149 who were questioned reported that they tried to assess the smoking status of their patients. The average time devoted to tobacco in a consultation was 4 minutes. Seventy-seven percent of those concerned knew what constituted "brief smoking cessation" and 59% reported delivering it regularly. The Fagerström test was known by 96% of them but only 13% of residents used it. With the exception of two residents in pneumonology, the Q. MAT, an assessment test of motivation to quit smoking, was unknown to them. Nicotine withdrawal symptoms were well recognised. Sixty-nine percent of them knew about the prescription list and 75% of them prescribed nicotine substitutes.

CONCLUSIONS

The approach to the smoking patient varied according to the resident's speciality. Smoking assessment was done systematically by most but did not always lead to an assessment of patients' motivation to stop smoking or to an offer of assistance with quitting. This observation led to the development of a tool to improve the approach to smokers, available within the CHRU intranet covering the principles of the management of the tobacco quitting process; informing, helping to stop feeling guilty, assessing the motivation to quit (Q.MAT), assessing the smoker's addiction (Fagerström test), offering assistance and a list of nicotine substitutes.