Salepci Banu, Fidan Ali, Çağlayan Benan, Parmaksız Elif Torun, Kıral Nesrin, Cömert Sevda Şener, Güngör Gülten Aktin, Salepci Egehan
Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey.
Student of 6 Grade, Trakya University Faculty of Medicine, Edirne, Turkey.
Turk Thorac J. 2016 Jan;17(1):15-21. doi: 10.5578/ttj.17.1.003. Epub 2015 Dec 14.
In 2011, in the context of a research project, bupropion and varenicline were distributed to smoking cessation clinics by the Ministry of Health of Turkey to be prescribed free of charge by a computer-based system. In the present study, we compared smoking cessation rates between patients who were prescribed free medications during the period of the project and those who had to pay for their medication.
Six hundred four patients who applied during the project period were given either bupropion or varenicline, which were prescribed using an algorithm-based computer system. Three hundred sixteen patients who applied after that period were prescribed medicines deemed appropriate by the attending physician but had to pay for the medication on their own. Follow-up visits were arranged for one year. Carbon monoxide (CO) levels in the expired air were used as indicators of cessation.
A total of 537 patients began treatment, of which 438 (81.6%) applied during the first period (group 1) and 99 (18.4%) applied during the second period (group 2). The mean age and concomitant disease presence were higher in the second-period patients (p< 0.05). Advanced age, comorbidities, pathological findings in spirometry, and chest X-ray were also higher in those who paid for the cost of their treatment (p= 0.009, 0.001, 0.006, 0.001, respectively). Smoking cessation rates were found to be 14.8% and 27.3% after six months (p= 0.008) and 10.7% and 18.2% after one year (p= 0.059), respectively, for group 1 and group 2. Age, dependence score, cigarettes smoked (as pack-years), and percentage of patients who paid for the treatment were found to be significantly higher (p< 0.001, 0.021, 0.018, 0.001, respectively) for those who quit smoking at the end of six months. For the patients who quit smoking at the end of one year, age was found to be significantly higher (p= 0.008), and the number of males was higher, although the difference was not statistically significant (p= 0.05). When logistic regression analysis was applied, age, dependence score, and paid treatment were found to be independent variables (p= 0.002, 0.008, 0.012, respectively) for those who quit smoking at the end of six months. Only age was found to be an independent variable for those who quit smoking at the end of one year (p= 0.029).
More smokers could receive treatment by the distribution of free drugs. However, quitting rates at the end of six months were higher when patients had to pay for their treatment. On the other hand, quitting rates at the end of one year were not affected by whether the treatment was paid for or free of charge. The most important factor increasing quitting rates at the end of six months and one year was found to be advanced age.
2011年，在一个研究项目的背景下，土耳其卫生部向戒烟诊所分发了安非他酮和伐尼克兰，以便通过计算机系统免费开处方。在本研究中，我们比较了在项目期间免费获得药物处方的患者与那些必须自行支付药物费用的患者之间的戒烟率。
在项目期间申请的604名患者被给予安非他酮或伐尼克兰，这些药物是使用基于算法的计算机系统开处方的。在该时间段之后申请的316名患者由主治医生开了认为合适的药物，但必须自行支付药物费用。安排了为期一年的随访。呼出气体中的一氧化碳（CO）水平用作戒烟指标。
共有537名患者开始治疗，其中438名（81.6%）在第一阶段申请（第1组），99名（18.4%）在第二阶段申请（第2组）。第二阶段患者的平均年龄和合并症发生率更高（p<0.05）。自行支付治疗费用的患者在高龄、合并症、肺功能检查中的病理结果以及胸部X光检查方面也更高（分别为p=0.009、0.001、0.006、0.001）。第1组和第2组在六个月后的戒烟率分别为14.8%和27.3%（p=0.008），一年后的戒烟率分别为10.7%和18.2%（p=0.059）。在六个月末戒烟的患者在年龄、依赖评分、吸烟量（以包年计）以及自行支付治疗费用的患者比例方面显著更高（分别为p<0.001、0.021、0.018、0.001）。对于在一年末戒烟的患者，年龄显著更高（p=0.008），男性数量更多，尽管差异无统计学意义（p=0.05）。当应用逻辑回归分析时，对于在六个月末戒烟的患者，年龄、依赖评分和自行支付治疗费用被发现是独立变量（分别为p=0.002、0.008、0.012）。对于在一年末戒烟的患者，仅年龄被发现是一个独立变量（p=0.029）。
通过免费药物分发，更多吸烟者可以接受治疗。然而，当患者必须自行支付治疗费用时，六个月末的戒烟率更高。另一方面，一年末的戒烟率不受治疗是否免费的影响。在六个月末和一年末提高戒烟率的最重要因素是高龄。
