Friday, July 25, 2008

How Health Care Professionals can Help Their Patients Quit Smoking

Tobacco dependence is a chronic condition that often requires repeated intervention.

•Chronic Disorder that is vulnerable to relapse that persists for weeks, months, years.
•Requires ongoing counseling similar to diabetes, hypertension or hyperlipidemia
•Tobacco dependence treatments are both clinically effective and cost effective relative to other medical and disease prevention interventions
•It is essential that clinicians institutionalize the consistent identification, documentation, and treatment of every tobacco user seen in a health care setting.
•70% of smokers see a physician each year
•70% of smokers have indicated they would like to quit
•Physicians advice to quit is important motivator
•Use of 5 “A’s”—Ask about tobacco use, Advise to quit, Assess willingness to quit, Assist in attempt to quit, Arrange follow-up

Ask about Tobacco Use: Expand vital signs to include tobacco use status that ensures screening for every patient at every visit.
•Screening will produce four responses:
Uses Tobacco and is willing to quit
Uses Tobacco and is unwilling to quit
Once used Tobacco but has quit (Repeated screening not necessary IF several years has past)
Never used Tobacco. (Repeated screening not necessary)

Advise to quit: Advice should be Clear, Strong and Personalized

Assess willingness to quit: Ask every smoker if they are willing to quit. Every patient that uses tobacco should be offered an intervention:
•Those willing to quit:
Prescribe and monitor pharmacological therapy
Provide brief counseling
Refer for intensive counseling service to increase success
•Those unwilling to quit should be provided a brief intervention
Use of Motivational interviewing around: Relevance, risks, rewards, roadblocks, repetition
•Recent Quitters: Engage in relapse prevention interventions
Reinforce decision to quit
Review benefits
Resolve residual problems
Adjust medications as needed

*Guidelines taken from the Clinical Practice Guideline for Treating Tobacco Use and Dependence issued by the US Department of Health and Human Services, Public Health Service

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