Tabakentwöhnung bei hospitalisierten Patienten:innen – Stationär einleiten, ambulant fortführen

Zusammenfassung

Tabakrauchen ist das größte vermeidbare Gesundheitsrisiko. Die Auswirkungen sind individuell und gesellschaftlich gravierend. Dennoch ist die Prävalenz aktuell Tabakrauchender in Deutschland mit ca. 35 % weiterhin hoch. Sorge bereitet zudem ein zuletzt starker Anstieg aktiv rauchender Jugendlicher (14- bis 17-Jährige, aktuelle Prävalenz ca. 16 %) und junger Erwachsener (18- bis 24-Jährige, aktuelle Prävalenz ca. 41 %). Etwa ein Drittel der stationär behandelten Patienten:innen rauchen. Die Hospitalisierung von aktiven Rauchern:innen in Akut- und Rehakliniken ist als „teachable moment“ ein günstiger Zeitpunkt, eine Tabakentwöhnung einzuleiten. Eine Intervention, die im Krankenhaus beginnt und nach der Entlassung mindestens einen Monat lang fortgesetzt wird, führt zu etwa 40 % zusätzlich entwöhnter Patienten:innen. Sie ist wissenschaftlich gut untersucht, effektiv und kosteneffizient. Die poststationäre Anbindung kann an ein Tabakentwöhnungsprogramm, eine Rehabilitationseinrichtung, ein Internet- oder Telefonangebot erfolgen. Es bestehen in Deutschland strukturierte und qualitätsgesicherte Angebote zur Umsetzung sowohl für den stationären als auch für den ambulanten Bereich. Größtes Hindernis für eine breite Etablierung solcher Angebote ist die fehlende Kostenerstattung. Zwei umsetzbare Wege, dies zu ändern, wären die Einführung eines Zusatzentgelts für den bestehenden OPS 9-501 „Multimodale stationäre Behandlung zur Tabakentwöhnung“ sowie die Etablierung von Qualitätsverträgen nach § 110a SGB V. Ein Ausbau der Tabakentwöhnung in Gesundheitseinrichtungen würde die Rauchprävalenz und die damit einhergehenden Erkrankungen sowie die konsekutiven Kosten nachhaltig reduzieren.

Abstract

Tobacco smoking is the greatest preventable health risk. The effects are serious, both individually and societal. Nevertheless, the current prevalence of tobacco smokers in Germany is still high at around 35 %. A recent strong increase in actively smoking adolescents (14- to 17-year-olds, current prevalence approx. 16 %) and young adults (18- to 24-year-olds, current prevalence approx. 41 %) is also a cause for concern. About a third of all inpatients continue smoking while being treated. The hospitalization of active smokers in acute and rehabilitation hospitals serves as a “teachable moment” for initiation of cessation offers. An intervention that begins in hospital and continues for at least a month after discharge results in about 40 % additional smokefree patients. It is scientifically well-researched, effective and cost-efficient. After initiation in hospital these measures can be continued via ambulatory cessation programs, rehabilitation facilities, an Internet or telephone service. In Germany, there are structured and quality-assured cessation offers, both for the inpatient and for the outpatient area. The biggest obstacle to broad establishment of such offers is the lack of reimbursement. Two feasible ways to change this would be the remuneration of the existing OPS 9-501 “Multimodal inpatient treatment for smoking cessation” and the establishment of quality contracts according to § 110a SGB V. An expansion of tobacco cessation measures in healthcare facilities would reduce smoking prevalence, associated burden of disease and consecutive costs.

Kernbotschaften

• Tabakrauchen ist das größte vermeidbare Gesundheitsrisiko mit einer hohen Prävalenz auch unter stationären Patienten:innen von etwa einem Drittel.

• Die Hospitalisierung in Akut- und Rehakliniken ist ein günstiger Zeitpunkt, eine Tabakentwöhnung bei aktiv rauchenden Patienten:innen einzuleiten.

• Die ambulante Fortführung einer stationär eingeleiteten Tabakentwöhnung zeigt hohe Erfolgsquoten und sichert den Therapieerfolg.

• Größtes Hindernis für eine breite Etablierung von Entwöhungsangeboten ist die fehlende Kostenerstattung. Ein Zusatzentgelt für den bestehenden OPS „Multimodale stationäre Behandlung zur Tabakentwöhnung“ oder die Etablierung von Qualitätsverträgen nach § 110a SGB V könnten das effektiv ändern.

Schlüsselwörter

Raucherprävalenz - Raucherentwöhnung - stationäre Einleitung - ambulante Fortsetzung - Möglichkeiten der Kostenerstattung

Keywords

Prevalence of tobacco use - smoking cessation - initiation in hospital - continuation in outpatients - models of reimbursement

Publikationsverlauf

Artikel online veröffentlicht:
25. April 2023

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