New guidelines call for smoking to be top priority
New guidelines call for smoking to be top priority
Occupational health providers should increase their efforts to help patients quit using tobacco, according to a report issued recently by the U.S. Public Health Service (PHS) in Washington, DC.
At the same time, a private sector panel of experts convened by the federal government challenged all clinicians, insurance plans, purchasers, and medical school officials to use the evidence in the new guideline to make treating tobacco dependence a top priority.
President Clinton also issued a memorandum directing executive departments and agencies to encourage federal employees to stop smoking, to promote greater use of available smoking cessation programs, and to review current federal tobacco cessation programs, in light of these new guidelines.
The PHS guideline, "Treating Tobacco Use and Dependence: A Clinical Practice Guideline," contains evidence-based information about first-line pharmacologic therapies (bupropion SR, as well as nicotine gum, patches, inhalers, and nasal sprays) and second-line therapies (clonidine and nortriptyline). It also highlights new evidence about how telephone counseling can help patients quit.
The guideline is aimed at practicing clinicians. Studies have shown that more than 25% of U.S. adults smoke and 70% of them would like to quit. Of those smokers who try to quit, those who have the support of their physician or other health care provider are the most successful, says Michael Fiore, MD, MPH. Fiore is chair of the guideline panel and director of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School in Madison.
"Anyone who uses tobacco and is committed to quitting needs to know that tobacco dependence is a chronic disease that, like high blood pressure or diabetes, frequently requires treatment over time to get it controlled," Fiore says. "In my view, a doctor isn’t providing an appropriate standard of care for patients if he or she doesn’t ask two key questions, Do you smoke?’ and Do you want to quit?’ and then work with that individual to make it happen."
Data show that only half of the smokers who see a doctor have ever been urged to quit, even though smoking is the single greatest preventable cause of illness and premature death in the United States. People who smoke are at increased risk of heart disease, cancer, and other smoking-related illnesses that contribute to more than 430,000 deaths a year.
Nationwide, medical care costs attributable to smoking (or smoking-related disease) have been estimated by the Atlanta-based Centers for Disease Control and Prevention (CDC) to be more than $50 billion annually. In addition, the CDC estimates the value of lost earnings and loss of productivity to be at least another $47 billion a year.
The guideline concludes that tobacco dependence treatments are both clinically effective and cost-effective relative to other medical and disease prevention interventions.
The guideline urges health care insurers and purchasers to include, as a covered benefit, the counseling and pharmacotherapeutic treatments identified as effective in the guideline and to pay clinicians for providing tobacco dependence treatment, just as they do for treating other chronic conditions.
The tobacco cessation guideline was developed by a consortium convened by the PHS that includes these organizations:
• the Centers for Disease Control and Prevention;
• the National Cancer Institute;
• the National Institute on Drug Abuse;
• the National Heart, Lung and Blood Institute;
• the Agency for Healthcare Research and Quality;
• the Robert Wood Johnson Foundation;
• the University of Wisconsin Medical School’s Center for Tobacco Research and Intervention.
[Copies of "Treating Tobacco Use and Dependence: A Clinical Practice Guideline," and a consumer guide called "You Can Quit Smoking" are available by calling (800) 358-9295 or writing to Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907-8547.] n
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.