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Helping Smokers Quit: A Guide for Physicians

Attachment D 

"Even brief tobacco dependence treatment is effective and should be offered to every patient who uses tobacco."

-  Public Health Service (PHS) Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update

Ask

Ask about tobacco use at every visit.

Implement a system in your clinic that ensures that tobacco-use status is obtained and recorded at every patient visit.

Vital Signs

Blood Pressure: ______________________________

Pulse: ____________  Weight: __________________

Temperature:_________________________________

Respiratory Rate:  ____________________________

Tobacco Use: Current        Former        Never        (circle one)

Advise

Advise all tobacco users to quit.

Use clear, strong, and personalized language. For example:

"Quitting tobacco is the most important thing you can do to protect your health."

Assess

Assess readiness to quit.

Ask every tobacco user if he/she is willing to quit at this time.

  • If willing to quit, provide resources and assistance (go to Assist section below).
  • If unwilling to quit at this time, help motivate the patient:
    • Identify reasons to quit in a supportive manner.
    • Build patient's confidence about quitting.

Assist

Assist tobacco users with a quit plan.

Assist the smoker to:

  • Set a quit date, ideally within 2 weeks.
  • Remove tobacco products from their environment.
  • Get support from family, friends, and coworkers.
  • Review past quit attempts—what helped, what led to relapse.
  • Anticipate challenges, particularly during the critical first few weeks, including nicotine withdrawal.
  • Identify reasons for quitting and benefits of quitting.

Give advice on successful quitting:

  • Total abstinence is essential—not even a single puff.
  • Drinking alcohol is strongly associated with relapse.
  • Allowing others to smoke in the household hinders successful quitting.

Encourage use of medication:

  • Recommend use of over-the-counter nicotine patch, gum, or lozenge; or give prescription for varenicline, bupropion SR, nicotine inhaler, or nasal spray, unless contraindicated.

Go to http://www.ahrq.gov/clinic/tobacco/medsmoktab.htm to view Suggestions for the Clinical Use of Medications for Tobacco Dependence Treatment.”  Refer to Attachment G for the CKHS prescription order set.

Provide resources:

  • Recommend toll free 1-800-QUIT NOW (784-8669), the national access number to State-based quitline services.

Refer to Web sites for free materials:

Arrange

Arrange follow-up visits.

Schedule follow-up visits to review progress toward quitting.

If a relapse occurs, encourage repeat quit attempt.

  • Review circumstances that caused relapse. Use relapse as a learning experience.
  • Review medication use and problems.
  • Refer to 1-800-QUIT NOW (784-8669).

For more information on prescribing, precautions, and side effects, go to the Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update www.ahrq.gov/path/tobacco.htm.

U.S. Department of Health and Human Services
Public Health Service

Current as of May 2008 


Internet Citation: 

Helping Smokers Quit: A Guide for Clinicians. Revised May 2008. Agency for Healthcare Research and Quality. Rockville, MD. http://www.ahrq.gov/clinic/tobacco/clinhlpsmksqt.htm

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