Centres for the Treatment of Tobacco: A change of pace is needed| Tabaccologia

Article

The theme of Word No Tobacco Day 2021 (Hurry to Quit / Commit to Quit [1]) was dedicated to the need to quit for each smoker, thus putting the spotlight on the Tobacco TreatmentCentres (CTT), also called Anti-Smoking Centres (CAF), which are the backbone of Smoking Cessation.

Unfortunately, the CTTs in Italy present a series of chronic criticalities, which do not favour the increase in number of smokers who turn to them to quit smoking.

It is useless not to admit that the CTTs are in an operational crisis due to problems that have never been resolved, which have accumulated over the past few years:

1. A first criticality is strictly numerical, that is linked to the number of CTTs operating on the national territory. The latest survey by the Istituto Superiore di Sanità (ISS) 2021 places them well below 300(268), a significant decrease compared to the number of a few years ago (396).
2. Another even more qualifying criticality is the efficiency with which they operate in the field of smoking cessation. Excluding these last 18 months of pandemic, about 18 thousand smokers access the CTTs every year, of which about 50% remain abstinent for one year, a high rate, but with very low absolute numbers, if compared to the approximately 12 million smokers in Italy.
3. The methodological approach is often very heterogeneous. While some CTTs operate at full capacity following the guidelines (GLs) for integrated therapy (counselling + pharmacotherapy), many other CTTs operate by treating a few patients in a year and / or using only counselling without exploiting the positive impact of available pharmacotherapy indicated by the GLs, which triples the number of smoking cessations.
4. The most important obstacle, however, is the lack of institutional formalisation of the CTTs at a regional / national level which does not allow an adequate number of CTTs on the territory and does not permit health professionals who want to engage in this field to have adequate continuous training on smoking.

The data clearly show that tobacco addiction is the first preventable cause of death in Western Countries. Up to 50% of smokers in our Country, as in other Regions of the World, will die from tobacco, and despite this we observe an inexplicable delay in giving to smoking services the dignity and resources that other services (eg. diabetes or hypertension treatment centres) obtained since a long time.

It’s quite a long time since The Italian Society of Tobaccology (SITAB) already identified the critical issues listed above as the primary objective of its actions. Since two years, the establishment of the National School of Medical Tobaccology [2] has been providing for training on Short Motivational Counselling (distance courses, FAD), on the treatment of tobacco smoking and training courses for specialised Centres.

More than 3,000 healthcare professionals have been trained or updated through these tools. Furthermore, as a Scientific Society, we are also collaborating with the ISS in drafting new National guidelines on addiction to tobacco and nicotine as we have already done with the 2018 and 2020 European Network for Smoking Cessation and Prevention (ENSP) guidelines, available in the Italian version on our website () [3].

Smoking cessation interventions, including short interventions such as Minimal Advice and Short Motivational Counselling, have a very advantageous cost/effectiveness ratio, sometimes considerably higher than other widespread interventions in medicine, such as some screenings and even therapies established in clinical practice for decades (Table 1).

It would be necessary, in a desirable and forthcoming reform of the National Health System, to establish a fund for tobacco control, as it has been established in France three years ago, possibly financed by an increase in the taxation of tobacco products themselves.

With a view to an eventual territorial reorganization, it would also be essential to create in each Public Health Local Establishment at least one CTT, equipped with trained and dedicated health operators, able to provide continuous services.

Finally, it would certainly be useful if the ISS, together with the Ministry of Health, provided directives and support for the training of tobacco service operators, in order to standardise treatments throughout the National territory, according to the GLs that will soon be available. The Italian Society of Tobaccology, also on the basis of the training skills developed in the National School of Medical Tobaccology, can sensibly contribute to increase good practice and Evidence Based approaches.

Tobacco prevention and treatment, based on validated programs, are an objective that a new health model can no longer ignore. Twelve million Italians need it.

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References

1. World Health Organization (WHO). World No Tobacco Day 2021 campaign - Commit to Quit.Publisher Full Text
2. Tinghino B. National School of Medical Tobaccology, un modello di formazione multilivello per la smoking cessation in Italia. Tabaccologia. 2020; 18:5-8.
3. European Network for Smoking and Tobacco Prevention (ENSP), Società Italiana di Tabaccologia (SITAB), Istituto di Ricerche Farmacologiche “Mario Negri”, IRCCS. Linee guida per il trattamento della dipendenza da tabacco 2020. European Network for Smoking and Tobacco Prevention Brussels. 2020.
4. Istituto Superiore di Sanità (ISS), Osservatorio Fumo, Alcol e Droga (OssFAD). Rapporto sul fumo in Italia 2010.Publisher Full Text