Set a quit date, ideally within two weeks of the office visit. Identify the patient’s core values (e.g., health, being a role model for children) and how smoking affects these values.Īssist the patient in his or her attempt to quit. Explore what he or she likes and does not like about smoking and the potential advantages and disadvantages of quitting. If the patient is unwilling to quit, identify why the patient is not motivated. If the patient is willing to make a quit attempt, offer medication, brief counseling, and self-help resources and schedule a follow-up visit. Use the patient’s level of motivation to determine the next step: Personalized: physicians should talk with patients about how smoking has affected their health, children, or other family members the social and economic costs of smoking and the patient’s readiness to quit.Īssess the patient’s willingness to quit.Īssess the patient’s willingness to quit by asking, “On a scale from 0 to 10, with 0 being ‘not at all motivated’ and 10 being ‘extremely motivated,’ how motivated are you to quit smoking?” Strong: “As your physician, I need to tell you that smoking cessation is one of the most important decisions you can make for your health.” Cutting down or changing to light cigarettes is not enough.” Placing tobacco-use status stickers on patient charts, noting tobacco use in electronic medical records, or using computer reminder systems also may be helpful.Ĭlear: “I think it is important for you to quit smoking now. Include questions about tobacco use when assessing the patient’s vital signs. Initial concerns about increased risk of seizures have not been confirmed.Ĭombination more effective than either agent aloneĬombination more effective than patch alone but not bupropion aloneĪsk about tobacco use during every office visit. Quit rates were higher in specialized cessation clinics than in primary care settings higher potential for addiction than the patch 6, 11 Similar results among smokers regardless of success or failure of previous pharmacologic therapy 17 Higher potential for addiction compared with other NRTs 15 Less potential for addiction compared with gum Materials that are tailored to individual smokers may be more effective than standard materials. Successful interventions usually require multiple (up to six per week) contacts with self-help materials near the time of the quit date. Indirect evidence suggests that “quitlines” can be useful in smoking cessation. There is no additional benefit when combined with other interventions (e.g., physician advice, pharmacotherapy). Overall effect likely to be small compared with no intervention. These agents have similar long-term success rates.Ĭlinical recommendation (smoking cessation interventions)īrief intervention is five minutes or less in a single visit. Food and Drug Administration for treatment of tobacco dependence include bupropion (a non-nicotine therapy) and nicotine replacement therapies in the form of a gum, patch, nasal spray, inhaler, and lozenge. The pharmacologic agents approved by the U.S. The effectiveness of nonpharmacologic treatments generally is lower therefore, pharmacotherapy is recommended for smokers who are willing to attempt cessation, unless medical contraindications exist. Behavior modification can improve long-term smoking cessation success even brief (five minutes or less) advice on smoking cessation during an office visit can increase cessation rates. Physicians can improve screening and increase cessation rates by asking patients about tobacco use at every office visit. Public Health Service recommends that primary care physicians use the five A’s (Ask, Advise, Assess, Assist, and Arrange) model when treating patients with nicotine addiction. Family physicians, who see most of these patients in their offices every year, have an important opportunity to decrease smoking rates with office-based interventions. Tobacco use, primarily cigarette smoking, is the leading cause of preventable morbidity and mortality in the United States, and nearly one third of those who try a cigarette become addicted to nicotine.
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