Posted 25 Jul, 2018
25 July 2018
First published in the Herald Sun (Melbourne, Australia) page 24.
Imagine if a new drug were to come onto the market tomorrow that reduced the side-effects of cancer treatments and made them more effective; a drug that improved pain management, reduced infection rates and increased wound healing after surgery; a drug that significantly improved recovery after a heart attack.
Patients would be knocking down the doors of the drug company to get their hands on it. The Pharmaceutical Benefits Scheme (PBS) would be working up the economic analyses before subsidising this drug to the tune of millions every year. Clinical leaders would be pushing their hospitals to change treatment guidelines and provide it to every suitable patient.
The benefits of this mythical drug are, in fact, exactly the benefits achieved when someone who has been diagnosed with cancer or is having surgery or has had a heart attack stops smoking.
And yet health professionals rarely refer patients who smoke to the Quitline or talk to them about the effectiveness of quitting medications.
Clinical trials have shown that combining behaviour change coaching provided by Quitline with nicotine replacement therapy (NRT) or a stop smoking drug significantly increases successful quitting. However, only one in five Victorian smokers who tries to quit uses this proven approach. This is almost certainly in part because patients are not routinely getting this advice about how to quit from their health professionals.
About 80% of Victorian smokers want to quit and they want help from health professionals. Last year, Quit surveyed smokers and recent quitters across Gippsland, the region with the highest smoking prevalence in Victoria, to gauge community views on GPs asking about smoking. The survey found that 31% of smokers and recent quitters said their GP should ask them about smoking at every visit, with 76% saying the GP should ask them “at least occasionally”.
So why isn’t giving medical advice and offering help to quit, followed—if the offer of help is accepted—by a referral to Quitline and free or subsidised medication just part of standard healthcare?
An economic analysis commissioned by Quit, which modelled the benefits of reaching a 5% daily smoking prevalence in Victoria (instead of the 10% we’re currently on track to achieve), found the State could justify the expenditure of many tens of millions of dollars over the next seven years to reach the 5% target and realise billions of dollars in savings.
Victoria already pays $602 million in healthcare costs every year due to smoking; surely we could afford to invest a little more now to help people access proven treatments and avoid far higher healthcare costs later. (The sort of argument any Department of Treasury and Finance would like to hear about a new case for investment.)
Successive State Governments (and the Department of Health & Human Services) have enabled hospitals to do many amazing things to improve clinical care and thus help Victorians live longer, healthier lives. Hospitals could be enabled—very simply and with little additional expenditure—to provide effective medicines and rapid referral to the State’s own, highly effective and cost-effective Quitline.
It’s a lost opportunity to not capitalise on existing public education campaigns, high taxes and smokefree legislation – all of which we know motivate and support smokers to quit – by making every contact point with our health system a point at which a smoker gets at least advice, but preferably help, to quit. Embedding smoking cessation in routine healthcare is a missing—but blindingly obvious—part of a comprehensive approach to helping Victorians quit. The State Government, irrespective of which party forms it, has the power to make smoking cessation part of routine hospital care and, in the process, save hundreds of thousands of Victorians from premature death and the poor quality of life that comes from chronic ill-health caused by smoking.