title: [The management of patients with nicotine dependence - the role of the general practitioners].
abstract: The gatekeeper needs a disease management of his patients who smoke. Questionnaires will help to define the diagnosis and grade of nicotine dependence as well as the fingerprint of the patients smoking career. The ICD-10 Code and the Fagerström Nicotine Dependence Test are used. There is no therapy indicated without the optimal motivation of the patient. The transtheoretical model of Prochaska and DiClemente ist widely accepted to separate the stadium of motivation into precontemplation, contemplation, preparation and action. Many other factors like earlier experiences, catastrophe scenaries, self-efficacy and selection of therapeutic modality are important for the best outcome. 90 % of the work of a gatekeeper is minimal intervention. This means individually tailored argumentations to shift the motivation of the patient to smoking cessation. The concept is defined in the rules of the five R's with relevance, risks, rewards, roadblocks and repetition. Following these criterias, the gatekeeper gets a positive shift of his motivation in up to 60 % with only one minimal intervention. The smoking cessation guidelines through the world are very similar and show a level A grade for a synergy of behavioural therapy and medication by either nicotine replacement, bupropion or vareniclin. The selection of any other regimen is either less efficient or anecdotally and leads to a further loss of life expectancy of the smoker. The gatekeeper has the infrastructure, the know how and the confidence of his patient to act as disease manager. A successful therapy is possible over six months with about seven consultations, the success rate is expected to be even higher than the values in the medication studies. Smokers should be informed by the health organizations to avoid self therapies and look for specialists help. The gatekeeper is an ideal candidate.
authors.affiliation: Praxis Dr. med. P. Ruff, Oberwil, Schweiz. ruff@ruffbox.ch
authors.forename: Paul
authors.initials: P
authors.lastname: Ruff
mesh_terms: D001521:Behavior Therapy; D001552:Benzazepines / Q000008:administration & dosage; D016642:Bupropion / Q000008:administration & dosage; D003131:Combined Modality Therapy; D019468:Disease Management; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage; D005194:Family Practice; D006801:Humans; D009042:Motivation; D009538:Nicotine / Q000008:administration & dosage; D018722:Nicotinic Agonists / Q000008:administration & dosage; D010817:Physician-Patient Relations; D011810:Quinoxalines / Q000008:administration & dosage; D055502:Secondary Prevention; D016540:Smoking Cessation / Q000523:psychology*; D013557:Switzerland; D014029:Tobacco Use Disorder / Q000523:psychology / Q000534:rehabilitation*; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D011810:Quinoxalines; D016642:Bupropion; D009538:Nicotine; D000068580:Varenicline