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Remote treatment helps villagers in southwest Japan trying to quit smoking

Naoki Nishimura uses a smartphone to talk with a doctor during a remote outpatient treatment program, at the village office in Ubuyama, Kumamoto Prefecture, on Oct. 21, 2019. (Mainichi/Kohei Shimizu)

UBUYAMA, Kumamoto -- Residents of this southwestern Japan village nestled in the mountains who hope to quit smoking are one of the first to benefit from a completely remote outpatient treatment program now spreading among municipal governments.

The program, in which smokers receive cessation treatment via smartphones or other mobile devices without ever having to see a doctor face-to-face, was launched about two years ago. Initial users were mainly from large companies, but the program has started to spread among local governments.

Remote treatment does not require patients to frequent a hospital, and is a perfect solution for residents of mountainous areas and other secluded places with no nearby medical institutions. With the dire financial situation surrounding Japan's National Health Insurance, municipal governments are raising hopes that if locals can break free from cigarettes then it could help cut medical spending.

The central government in July 2017 launched completely remote outpatient treatment to quit smoking as part of its measures against secondhand smoke for the 2020 Tokyo Olympic and Paralympic Games. However, the program must be offered through corporate health insurance associations and other trusted organizations.

The screen of a smartphone showing an app through which patients take part in remote outpatient treatment can make a reservation, is seen at the village office in Ubuyama, Kumamoto Prefecture, on Oct. 21, 2019. (Mainichi/Kohei Shimizu)

According to four major Japanese firms offering the program, roughly 4,300 workers with 159 companies including a major enterprise in the metropolitan area had undergone remote treatment as of the end of October. Tokyo-based Linkage, the leading provider, began to offer the program to municipal governments from October for the first time, enabling residents of the Kumamoto Prefecture village of Ubuyama enrolled in National Health Insurance to get treated remotely.

There is only one clinic in the village, situated among the mountains along the prefectural border with Oita. Until now, those who wanted to receive outpatient treatment to quit smoking had to visit a neighboring municipality some 30 kilometers away. Kumamoto Kinoh Hospital in the city of Kumamoto, working closely together with the clinic in Ubuyama, acted as an intermediary, helping the Ubuyama Municipal Government and Linkage to mull the introduction of the program starting last year.

During fiscal 2017 medical checkups, 17.8% of the approximately 1,500 residents said they smoke, far outnumbering the national average of smokers at 14.1%.

The number of cases in which local residents visited doctors for respiratory diseases is twice as high as the national average. Medical expenses for lung cancer, sleep apnea and other symptoms believed to be related to smoking are one of the financial burdens on the village's national health insurance coverage.

Hiroshi Takamiya, 48, head of the municipal government's health and welfare department, said, "Many people who are working for a company quit smoking as the move to separate smoking and non-smoking areas or ban smoking builds in the company. But in this village where many people work as farmers, there's no one to stop them (from smoking) and there are no advances in the banning of cigarettes."

Livestock farmer Naoki Nishimura, 46, who says he is trying for a third time to stop smoking, consulted with a doctor from the village office via a video call for the first time late in October. Using a smartphone with a special app downloaded on it, he received a medical examination by interview and provided the doctor with information such as the reason why he smokes.

The doctor pointed out Nishimura's habit of smoking around 20 cigarettes a day, and advised the 46-year-old to instead chew gum or use eye drops when he feels the urge to smoke.

During a 2-month long period, patients consult the doctor four times via video calls and receive a smoking-cessation aid delivered to their house. After that, they report on their progress once every three months and receive follow-up treatment. Patients can make a reservation and call the doctor from anywhere, even when having a break while working in the field.

"I'm worried about my health and it costs money (to smoke). So, I am hoping this will be my final attempt at quitting smoking," Nishimura commented on the remote treatment.

There were originally six male residents participating in the program when it was introduced to the village in October, and one female patient decided to start in December. Nishimura has successfully stopped smoking for over a month now.

Takamiya commented, "We would like to support people trying to quit smoking as a village and promote good health among residents."

(Japanese original by Kohei Shimizu, Kumamoto Bureau)

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