Doctors seeking more resources to support those trying to stop smoking – obstacles posed by lack of time and inadequate treatment paths

Before reaching fifty, Finnish smokers already show warning signs of serious cardiovascular events. Support for quitting provided by doctors is a cost-effective method of preventing the realisation of serious health risks, but Finnish doctors feel that a lack of time and inadequate treatment paths prevent them from offering sufficient support.

In PhD research on the risk to 46-year-old Finnish smokers of developing serious cardiovascular problems over the following 10 years, the risk was found to be twice as high as for those that had either never smoked or had smoked previously but given up already at least one month earlier. There were also signs of higher metabolic syndrome risks: smokers had on average higher triglyceride readings, a less favourable waist–hip ratio, and type 2 diabetes was twice as common among them as among those who had never smoked, even after the participants’ body mass index had been taken into account. Typically, metabolic syndrome is thought to relate only to excess weight.

Smokers’ increased risk of cardiovascular problems is normally realised at a later age. The smokers participating in the research, however, were already using primary health care services more often than non-smokers while still aged under fifty. In practice, the difference was comprised of increased visits to health centres and occupational health care. “In financial terms, this difference amounted to 25% higher annual primary health care expenses”, summarises Doctoral Researcher Jaana Keto.

These results come from Ms Keto’s doctoral research, which investigated the relationship between smoking history, cardiovascular risk factors, and use of primary health care services among a 46-year-old North Finland cohort born in 1966. The members of the cohort were monitored using questionnaires and clinical research starting from their birth. The research also investigated Finnish doctors’ smoking-related attitudes and actions.

Quitting smoking during middle age can prevent the realisation of health risks and multimorbidity in later life. “In some countries, smokers avoid primary health care services, which makes the prevention of later diseases more difficult. This doesn’t seem to be the case in Finland. In fact, Finnish doctors have a golden opportunity to help patients to quit smoking in middle age, provided that the increased risk factors are recognised as warning signs”, Ms Keto explains.

It is already known that smoking cessation support provided by doctors is cost-effective. This support involves discussions, referral to a peer support group or specialist nurse, recommendation of nicotine replacement products or prescription of withdrawal medication. According to reports produced by the National Institute for Health and Welfare, a majority of Finnish smokers want to quit but only a minority had spoken about the matter with a doctor. “In order to understand this imbalance, doctors were surveyed about smoking”, Ms Keto says. A total of 1141 Finnish doctors participated in the research.

The participating doctors saw it as their responsibility to try to get smoking patients to quit, but the practical measures available for dealing with tobacco addiction were few. The most commonly reported obstacles were a lack of time and inadequate treatment paths. In Ms Keto’s opinion, these obstacles can be dealt with at the management and government level if there is the desire to tackle them.

Of the doctors participating in the research, four out of five supported increased allocation of resources to smoking cessation services. Less than a third felt smoking cessation was even somewhat well organised in the Finnish health care system. The world health organisation (WHO) is also of the opinion that there is room for improvement in Finland in smoking cessation services and in the integration of tobacco addiction treatment into the healthcare system, even though Finland is a global leader in smoking reduction through taxation and smoking bans.

Master of Agricultural and Forest Science (health and pharmaceutical biotechnology) Jaana Keto will defend her doctoral dissertation at the University of Oulu on Friday 26 January 2018. The public examination will take place in Auditorium 10 of the main building of the University of Helsinki (Fabianinkatu 33, 00170 Helsinki) starting at 12:15.

Link to the doctoral dissertation announcement

Last updated: 19.1.2018