Análise da efetividade do tratamento do tabagismo no Sistema Único da Saúde em Roraima: fatores preditores de sucesso

Abstract

Tobacco is the major cause of preventable illness and deaths worldwide, being part of the causal chain of at least 50 illnesses. Currently, there are about 1.1 billion smokers in the world (30% of the world population) and in Brazil it is estimated the prevalence between 14.8% and 17.2%. The treatment of smoking has been shown to be one of public health strategies with better cost-effectiveness relationship, regardless of the approach used. Access to smoking cessation treatment in Brazilian Public Health System (SUS) has been expanded more significantly from 2004, and in 2010 was instituted in the UISAM (Boa Vista) the first center for smoking treatment in Roraima. The aim of this study is to evaluate the effectiveness of the smoking treatment in the SUS in Roraima, identifying possible predictors of success. The dissertation consists of an initial part that contextualizes the smoking epidemic as a public health problem from an economic perspective. The second part is the result of a retrospective cohort study including 73 patients treated at UISAM between 2010 and 2011. The primary outcome was the rate of therapeutic success, defined the maintenance of cessation at 12 months. The secondary outcome was the rate of partial success, defined as cessation of smoking, but with return to smoking habit at the end of 12 months. After descriptive analysis, were correlated possible predictors of success with outcomes. We used the chi-square and Fisher exact test for the selection of the factors included in the multivariate analysis. The sample was predominantly females (64.4%) with a mean age of 48 (± 10.2) years, high educational level (82.2% with high school or more), with early smoking initiation (before 20 years in 90%), average consumption before starting treatment of 33 (± 10.2) years, the estimated degree of dependence trough Fargerström test was high or very high (65.7%) and motivational stage ready for action (53.4%). Adherence to treatment was good (72.6% of participants attended at least three structured sessions) with 86.3% having used drug support. About 75% of patients stopped smoking (partial success), and 30.1% maintained abstinence for more than 12 months after the start of treatment (therapeutic success). The use of drug support was positively associated with partial success (RR: 35.4; 95% CI 1.8 to 685), while the factors associated with therapeutic success were good adherence to cognitive-behavioral therapy (RR: 6.3; 95% CI: 1.1 to 37.4), the presence of previous treatment (RR: 6.1, 95% CI 1.2 to 30.6) and male gender (RR: 5.4; 95% CI 1,1 to 25, 9). The smoking cessation treatment as recommended by the Brazilian National Tobacco Control Program has good effectiveness in the local scene and should be encouraged to expand.