Accessibility of smoking cessation clinics in Turkey: a descriptive study among a population of smokers in İstanbul

Year 2022, Volume: 20 Issue: 3, 280 - 293, 01.12.2022

Tevfik Bayram , Şeyma Görçin Karaketir , Fatma Özer Yağmur Tatar Mehmet Kılınckıran Nur Can Dilşad Save

https://doi.org/10.20518/tjph.916741

Cited By: 4

Abstract

Objective: In 2011, Turkey started the nationwide “Smoking Cessation Treatment Support Program” via Smoking Cessation Clinics (SCC). This study examined the accessibility of these clinics using Levesque’s framework of access to healthcare services. From the (potential) users’ perspectives, it was aimed to find the challenges they face in accessing these clinics, and it proposed solutions for better implementation.

Methods: This study was conducted among 304 smokers who visited four Family Health Centers in a geographically defined area in Istanbul, Turkey, in 2018.

Result: In this study, it was found that 74% of smokers wished to quit smoking. Within them, 21% didn’t know of SCCs, and half of them didn’t know what services were provided there. Among those who knew of SCCs, 30% used them to quit smoking. The majority (75.7%) of the SCC users found the medications expensive; 41% didn’t use them, and 64% didn’t re-visit the clinics for follow-ups. Eventually, 4.3% of smokers quit smoking through SCCs. Utilization of these clinics were significantly higher among women (35%) than men (18.6%) (p=0.024). T; and there was no other differences in terms of age, marital status, income, and education level.

Conclusion: Smoking cessation programs in Turkey and other countries can be implemented more efficiently if the sufficient number of clinics are opened and are accessible at the local level; more health professionals are trained to practice; the clinics are made more visible; smoking cessation medications are made available constantly; and closer monitoring of service users is ensured.

Keywords

Smoking Cessation, Access To Health Care, Health Plan Implementations, Turkey

Thanks

We would like to thank Veene Sulaivany for English language editing.

Türkiye’de sigara bırakma polikliniklerinin erişilebilirliği: İstanbul’da sigara içen bir popülasyon arasında tanımlayıcı bir çalışma

Abstract

Amaç: Türkiye’de, 2011 yılında Sigara Bırakma Poliklinikleri (SBP) ile birlikte ülke çapında “Sigara Bırakma Tedavisi Destek Programı” hayata geçirilmiştir. Bu çalışmada Levesque’in sağlık hizmetlerine erişimi tanımlayan kavramsal çerçevesini kullanarak SBP’nin erişilebilirliğini inceledik. SBP’ye başvuru potansiyeli olan kişilerin açısından polikliniklere erişimdeki zorlukları tespit etmeyi ve daha iyi bir uygulama için çözümler önermeyi amaçladık.

Yöntem: Araştırma 2018 yılında, İstanbul’da dört Aile Sağlığı Merkezini ziyaret eden 304 sigara içicisinin katılımıyla yapılan tanımlayıcı bir çalışmadır.

Bulgular: Katılımcıların %74’ü sigarayı bırakmak istediğini belirtmiştir. Sigarayı bırakmak isteyenlerin ise %21’i SBP’lerin varlığını, yarısı ise SBP’de hangi hizmetlerin verildiğini bilmemektedir. SBP’yi bilenlerin %30’u sigarayı bırakmak için SBP’ye başvurduğunu belirtirmiştir. SBP başvuranların çoğunluğu (%75.7) ilaçları pahalı bulmuş; %41’i kullanmamış ve %64’ü takip için tekrar başvurmamıştır. Sonuç olarak, sigara içenlerin %4.3’ü SBP aracılığıyla sigarayı bıraktığını bildirmiştir. Bu polikliniklerden yararlanma kadınlarda (%35) erkeklerden (%18.6) anlamlı olarak daha yüksek bulunmuştur (p = 0,024). Yaş, medeni durum, gelir ve eğitim düzeyi açısından istatistiksel olarak farklılık saptanmamıştır.

Sonuç: Sigara bırakma programları hem ülkemizde hem dünyada yeterli sayıda poliklinik varlığında, yerel düzeyde erişilebilir olduğunda, daha fazla sağlık profesyoneli bu hizmet özelinde eğitildiğinde, poliklinikler daha görünür olduğunda, sigara bırakmayı destekleyen ilaçların temini devamlı olduğunda ve başvuranlar yakından takip edildiğinde daha verimli bir şekilde uygulanabilir.

Keywords

Sigara bırakma, sağlık hizmetlerine erişim, sağlık planı uygulamaları, Türkiye

References

• Çelik I, Yüce D, Hayran M, et al. Nationwide Smoking Cessation Treatment Support Program- Turkey project. Health Policy 2015;119(1):50-56.
• Nichter M, Çarkoğlu A, Nichter M, Özcan Ş, Uysal MA. Engaging nurses in smoking cessation: Challenges and opportunities in Turkey. Health Policy 2018;122(2):192- 197.
• Karadogan D, Önal Ö, Say Şahin D, Kanbay Y, Alp S, Şahin Ü. Treatment adherence and short-term outcomes of smoking cessation outpatient clinic patients. Tob Induc Dis 2018;16(38):1-10.
• Kocak ND, Aka Akturk U. What Factors Influence Non-Adherence to the Smoking Cessation Program? Turkish Thorac J 2019;20(3):168-174.
• Egici MT, Öztürk GZ, Bukhari MH, Toprak D. Smoking Cessation with Medication and Behaviour Therapy. Pakistan J Med Sci 2017;33(6):1459-1462.
• Bahadir A, Iliaz S, Yurt S, Ortakoylu MG, Bakan ND, Yazar E. Factors affecting dropout in the smoking cessation outpatient clinic. Chron Respir Dis 2016;13(2):155-161.
• Teker AG, Lüleci NE. Follow-Up Study Results of Patients of a Cigarette Cessation Clinic and Factors Affecting These Results. Turkiye Klin J Med Sci 2017;36(4):216- 224.
• Baltaci D, Aydin LY, Alasan F et al. Evaluation of smoking cessation practice by physicians for hospitalized patients in a tertiary hospital. J Pak Med Assoc 2016;66(12):1547-1553.
• Can G, Oztuna F, Ozlü T. The evaluation of Outpatient Smoking Cessation Clinic results. Tuberk Toraks 2004;52(1):63-74.
• Demir T, Tutluoğlu B, Koç N, Bilgin L. One-year follow up results of smoking cessation outpatient clinic. Tuberk Toraks 2004;52(1):63-68.
• Marakoğlu K, Çetin Kargın N, Merve Uçar R, Kızmaz M. Evaluation of pharmacologic therapies accompanied by behavioural therapy on smoking cessation success: a prospective cohort study in Turkey. Psychiat Clin Psych 2017;27(3):221-227.
• Koçak ND, Eren A, Boğa S et al. Relapse rate and factors related to relapse in a 1-year follow-up of subjects participating in a smoking cessation program. Respir Care 2015;60(12):1796-1803.
• Yaşar Z, Kurt ÖK, Talay F, Kargı A. One-year follow-up results of smoking cessation outpatient clinic: factors affecting the cessation of smoking. Eurasian J Pulmonol 2014;16(2):99-104.
• Ucar EY, Araz O, Yilmaz N et al. Effectiveness of pharmacologic therapies on smoking cessation success: Three years results of a smoking cessation clinic. Multidiscip Respir Med 2014;9(1):1-5.
• Akkaya A, Öztürk Ö, Cobanoglu H, Bircan HA, Şimşek Ş, Şahin Ü. Evaluation of patients followed up in a cigarette cessation clinic. Respirology 2006;11(3):311-316.
• Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12(1):1-9.
• Turkish Statistical Institute. Address Based Population Registration System Statistics: Population of Provinces by Years [online]. Available at: www.turkstat. gov.tr/PreTablo.do?alt_id=1059. Accessed July 4, 2019.
• Miller WR, Rollnick S. Motivational interviewing: Preparing people to change addictive behavior. New York; The Guilford Press, 1991.
• Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville: Substance Abuse and Mental Health Services Administration, 1999.
• Poland BD, Frohlich K, Haines RJ, Mykhalovskiy E, Rock M, Sparks R. The social context of smoking: The next frontier in tobacco control? Tob Control 2006;15(1):59-63.
• Frohlich KL, Potvin L. Collective lifestyles as the target for health promotion. Can J Public Heal 1999;90(1):11-14.
• Wang F, Luo W. Assessing spatial and nonspatial factors for healthcare access: Towards an integrated approach to defining health professional shortage areas. Heal & Place 2005;11(2):131-146.
• Nagelhout GE, Willemsen MC, van den Putte B, de Vries H, Willems RA, Segaar D. Effectiveness of a national reimbursement policy and accompanying media attention on use of cessation treatment and on smoking cessation: A real-world study in the Netherlands. Tob Control 2015;24(5):455-461.
• Akova S. Examination of public service announcements samples with the slogan “quit smoking, not living” via reception analysis. Strat ve Sos Araştırmalar Derg 2018;1(2):15-36.
• Yaman F, Göçkan I. The effect of public spotligth advertising on smokers: an application in Afyonkarahisar. Kafkas University Faculty of Economics and Administrative Sciences Journal 2015;6(11):53-65.
• Flay BR. Mass media and smoking cessation: A critical review. Am J Public Health 1987;77(2):153-160.
• Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking: a review. Ann N Y Acad Sci 2012 Feb;1248(1):107-123.
• Field K. Measuring the need for primary health care: An index of relative disadvantage. Appl Geogr 2000;20(4):305- 332.
• Nardini S. The smoking cessation clinic. Monaldi Arch Chest Dis 2000;55(6):495- 501.
• Ünal E. How the government intervention affects the distribution of physicians in Turkey between 1965 and 2000. Int J Equity Health 2015;14(1):1-13.
• Coleman T, Pound E, Adams C, Bauld L, Ferguson J, Cheater F. Implementing a national treatment service for dependent smokers: initial challenges and solutions. Addiction 2005;100(2):12-8.
• Bauld L, Coleman T, Adams C, Pound E, Ferguson J. Delivering the English smoking treatment services. Addiction 2005;100(2):19-27.
• Salize HJ, Merkel S, Reinhard I, Twardella D, Mann K, Brenner H. Cost-effective primary care-based strategies to improve smoking cessation: more value for money. Arch Intern Med 2009;169(3):230-235.
• Kocak ND, Aka Akturk U. What Factors Influence Non-Adherence to the Smoking Cessation Program? Turkish Thorac J 2018;20(3):168-174.
• T.R. Ministry of Health, Healthy Life Centers [online]. Available at: https:// shm.saglik.gov.tr/hizmetlerimiz/52- tütün-ve-madde-bağımlılığı-danışmanlığı. html. Accessed June 14, 2022.
• Tural Önür S, Uysal MA, İliaz S et al. Does short message service increase adherence to smoking cessation clinic appointments and quitting smoking? Balkan Med J 2016;33(5):525-531.
• Shearer J, Shanahan M. Cost effectiveness analysis of smoking cessation interventions. Aust N Z J Public Health 2006;30(5):428-434.