Dejavniki, povezani z uspešnim zdravljenjem odvisnosti od kajenja s pomočjo farmakoterapije

Drešček, Marko (avtor), Homar, Vesna (mentor), Orešković, Stjepan (komentor)

Izhodišča Kajenje je pomemben svetovni zdravstveni problem, ki prispeva k prezgodnji smrti in invalidnosti. Slovenija ima nižjo razširjenost kajenja v primerjavi s povprečjem EU, kar poudarja potrebo po nadaljnjih učinkovitih ukrepih za nadzor tobaka. Na primarni ravni zdravstvenega varstva poteka prepoznava in prva obravnava kajenja v okviru Programa integrirane preventive kroničnih nenalezljivih bolezni pri odraslih. Primarna raven ponuja različne možnosti pomoči pri opuščanju kajenja pri izbranem osebnem zdravniku, diplomirani medicinski sestri v Centrih za krepitev zdravja in v Zdravstveno vzgojnih Centrih. Farmakoterapija za pomoč pri opuščanju kajenja pa se v Sloveniji redko uporablja in malo je znanega o njenem pomenu in vlogi pri opuščanju kajenja. Namen Namen raziskave je bil ugotoviti značilnosti bolnikov, ki so bili uspešni pri opustitvi kajenja s pomočjo farmakoterapije, identificirati dejavnike, povezane z uspešnim prenehanjem kajenja s pomočjo farmakoterapije, ter razložiti njihov pomen in težo pri uspešnem prenehanju kajenja. Metode Izvedli smo dvostopenjsko multicentrično raziskavo, sestavljeno iz presečne kohortne raziskave in prospektivne klinične intervencije. V presečni raziskavi je sodelovalo 24 ambulant. Skupaj je bilo oddanih 717 vprašalnikov presečne raziskave. V interventnem delu raziskave je sodelovalo 21 ambulant. Skupaj so oddale 176 protokolov. Raziskava je potekala od 14. 7. 2020, ko je bil vključen prvi pacient, do 4. 11. 2022, ko je s spremljanjem zaključil zadnji pacient. Raziskavo je odobrila Slovenska nacionalna komisija za medicinsko etiko (KME 0120/133/2019/4). Instrumenti Uporabili smo Fagerströmov test odvisnosti od nikotina in vprašalnik »Anketa o kajenju«. Vprašalnik »Anketa o kajenju« smo za potrebe naše raziskave prilagodili po vprašalniku, opisanem v članku »Barriers to and Interest in Lung Cancer Screening Among Latino and Non-Latino Current and Former Smokers«. Analiza podatkov Za spremljanje in upravljanje podatkov v realnem času smo v raziskavi uporabili platformo REDCap. Statistična obdelava podatkov je bila izvedena z uporabo programske opreme IBM SPSS Statistics, verzija 29. Rezultati Poskus opustitve kajenja z zdravili na recept je bil uspešen pri 24,4 % (95 % IZ: 18,1-30,7 %), kadilcev. Multivariatna logistična regresijska analiza je potrdila pomen adherentnosti in stopnje odvisnosti od nikotina kot ključnih napovedovalcev za uspešno opustitev kajenja. Fagerströmov test je bil statistično značilen (RO = 0,75; 95 % IZ: 0,58–0,96; p = 0,02), kar pomeni, da večja odvisnost zmanjšuje verjetnost uspešne opustitve. Adherenca pa je pokazala še močnejši napovedni učinek (RO = 3,53; 95 % IZ: 1,47–8,51; p < 0,01). Druge spremenljivke, vključno s starostjo, izobrazbo, številom otrok, izkušnjami s preteklimi poskusi prenehanja in subjektivno oceno zdravja, niso bile povezane z uspešnim izidom opustitve kajenja s pomočjo farmakoterapije. Sklepi Odvisnost od nikotina in upoštevanje farmakoterapije sta najmočnejša napovedna dejavnika uspešnega poskusa opustitve kajenja. Tako identifikacija možnih odzivnikov in predpisovanje farmakoterapije kot nadaljnje spremljanje se lahko izvajajo v osnovnem zdravstvenem varstvu.

• Jezik: Slovenski jezik
• Ključne besede: uporaba tobaka, odvisnost od nikotina, opuščanje kajenja, farmakoterapija, družinska medicina
• Vrsta gradiva: Doktorsko delo/naloga
• Organizacija: MF - Medicinska fakulteta
• Leto izida: 2025
• PID: 20.500.12556/RUL-178428
• Datum objave v RUL: 27.01.2026

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Factors associated with successful treatment of smoking addiction with pharmacotherapy

Izvleček

Background Smoking is a major global health problem that contributes to premature death and disability. Slovenia has lower prevalence of smoking compared to the EU average, which highlights the need for continuous effective tobacco control measures. At the primary health care level, smoking is identified and first treated within the framework of the Integrated Prevention of Chronic Non-Communicable Diseases in Adults Program. The primary health care level offers various options for helping to quit smoking with a selected personal physician, a registered nurse in the Health Promotion Centers and in the Health Education Centers. Pharmacotherapy to help quit smoking is rarely used in Slovenia and little is known about its importance and role in quitting smoking. Aim The aim of the study was to determine the characteristics of patients who are most likely to benefit from pharmacotherapy for smoking cessation, to identify factors associated with successful smoking cessation using pharmacotherapy, and to explain their importance and weight in successful smoking cessation. Methods We conducted a two-stage multicenter study consisting of a cross-sectional cohort study and a prospective clinical intervention. 24 clinics participated in the cross sectional study. A total of 717 cross-sectional survey questionnaires were submitted. 21 clinics participated in the intervention part of the study. A total of 176 protocols were submitted. The study was conducted from 14. 7. 2020, when the first patient was included, to 4. 11. 2022, when the last patient completed follow-up. The study was approved by the Slovenian National Commission for Medical Ethics (KME 0120/133/2019/4). Instruments We used the Fagerström Nicotine Dependence Test and the “Smoking Questionnaire”. The “Smoking Questionnaire” questionnaire was adapted for our study from the questionnaire described in the article “Barriers to and Interest in Lung Cancer Screening Among Latino and Non-Latino Current and Former Smokers”. Data analysis We used the REDCap platform for real-time data monitoring and management in the study. Statistical data processing was performed using IBM SPSS Statistics, version 29. Results Attempts to quit smoking with prescription medications were successful in 24.4% (95% CI: 18.1–30.7%) of smokers. Multivariate logistic regression analysis confirmed the importance of adherence and nicotine dependence as key predictors of successful smoking cessation. The Fagerström test was statistically significant (OR = 0.75; 95% CI: 0.58–0.96; p = 0.02), indicating that greater dependence decreases the likelihood of successful cessation. Adherence showed an even stronger predictive effect (OR = 3.53; 95% CI: 1.47–8.51; p < 0.01). Other variables, including age, education, number of children, experience with previous quit attempts, and subjective health assessment, were not associated with successful smoking cessation outcome with pharmacotherapy. Conclusions Nicotine dependence and adherence to pharmacotherapy are the strongest predictors of successful smoking cessation attempts. Both identification of potential responders and prescription of pharmacotherapy and follow-up can be performed in primary health care.

• Ključne besede: tobacco use, tobacco use disorder, smoking cessation, drug therapy, family medicine