Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Physicians (in progress...)

Physicians are in a special position to motivate their clients to change and thus significantly reduce smoking among their clients.

Emergency Physicians1:

  • "Despite tobacco use's high prevalence and burden of morbidity among emergency department patients, it is not part of the core curriculum taught to U.S. emergency physicians."
  • Tobacco use and tobacco-related illnesses are common among emergency department patients
  • A number of multisite studies found smoking prevalence rates ranging between 30%-40% among adult emergency department patients--much higher than the national prevalence
  • A single-site study found tobacco to be directly linked to 5% of emergency visits and 10% of emergency admissions
  • Adult smokers have been found to be interested in cessation, and in receiving a cessation intervention in the context of the emergency department

Primary Care Physicians:

 

 

Five A’s

Ask about tobacco use

Identify and document tobacco use status for every patient at every visit

Advise to quit

In a clear, strong, and personalized manner, urge every tobacco user to quit.

Assess willingness to make a quit attempt

Is the tobacco user willing to make a quit attempt at this time?

Assist in quit attempt

For the patient willing to make a quit attempt, offer medication and provide or refer for counseling or additional treatment to help the patient quit.

 

For patients unwilling to quit at the time, provide interventions designed to increase future quit attempts.

Arrange follow up

For the patient willing to make a quit attempt, arrange for follow up contacts, beginning within the first week after the quit date

 

For patients unwilling to make a quit attempt at the time address tobacco dependence and willingness to quit at next clinic visit

Table adapted  from Treating Tobacco Use and Dependence, Clinical Practical Guideline, 2008 Update

 

Patient Willing to Quit

-Be sure to evaluate the smoking status of all patients entering clinic

-Inform that Patient that it is necessary to quit smoking, tie cessation into the chief compliant of the patients visit to the clinic

-Assess the wiliness to quit

            -Willing to quit then provide resources, treatment, follow up

            -Unwilling to quit provide intervention

-Form a cessation plan: set a quit date, discard of all tobacco products, make your home smoke free, and discuss possible symptoms of withdrawal, challenges and strategies to deal with them, inform family and friends for their support

-Prescribe medication

-Counseling: discuss the importance of total abstinence, positives and negatives of previous quit attempts, abstaining from alcohol use, and family or friends who smoke (contribute to relapse), remind the patient that the physician is always available for help, provide resources to quit lines.

-Arrange follow up for the Patient

 

Patient Unwilling to Quit

 

-Motivational Interviewing (MI): patients conversing to the physician about smoking has proven more helpful then a lecture for quitting.

1. Express Empathy: Open ended question and Reflective listening

2. Develop discrepancy:

3. Roll with resistance

4. Support Self Efficacy

-5R’s helpful tool

1. Relevance

2. Risks

3. Rewards

4. Roadblocks

5. Repetition

 

Patients who have recently quit

-High risk of relapse

-medication and intense cessation counseling prevent relapse

-reinforce the success at quitting, review benefits of cessation, and assist with any problems in the cessation process

-congratulate the patient on quitting, use open ended questions to ask about cessation process

-a physician’s interest in the patient’s cessation process can encourage the patient to seek outside counseling to avoid relapse

 

Helpful Links

The American Medical Association A private sector panel of experts developed a How-To Guide for Clinicians which provides information on first-line pharmacologic therapies and counseling to help clients quit using tobacco.

The American Academy of Family Physicians (AAFP) "Ask and Act Practice Toolkit" includes a number of tobacco cessation resources that can be utilized to help your patients quit.

The National Cancer Institute offers an entire monograph regarding information on smoking interventions for medical and dental practices (http://cancercontrol.cancer.gov/tcrb/monographs/5/index.html).

The American College of Chest Physicians provides an online course for physicians covering the impact of tobacco dependence, treatment, relapse prevention, and special populations of tobacco users.

CLICK HERE to find out more about the link between Smoking and Mesothelioma from the the Asbestos and Mesothelioma Center.

Drs. Fiore and Baker (2011) present a review of formal guidelines and clinical recommendations for treating smokers in the health care setting. CLICK HERE to view the article, published in The New England Journal of Medicine.

Fax to Assist

If you are employed by a HIPAA-covered facility, please CLICK HERE for more information on Fax to Assist and our Fax Referral Program.

References: 

1 Bernstein, S.L., Boudreaux, E.D., Cabral, L., Cydulka, R.K., Schwegman, D., Larkin, G.L., Adams, A.L., McCullough, L.B., & Rhodes, K.V. (2009). Efficacy of a brief intervention to improve emergency physicians' smoking cessation counseling skills, knowledge, and attitudes. Substance Abuse, 30, 158-181.