New
Guidelines Challenge All Clinicians to Help Smokers Quit
June 27, 2000
Health care
professionals have new evidence and tools to help patients quit using
tobacco, according to a report issued by the U.S. Public Health Service
(PHS). A private-sector panel of smoking cessation 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 has
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.
"There has never
been a better time for health professionals to help their patients break
free from the deadly chronic disease we know as tobacco addiction,"
said David A. Satcher, MD, Assistant Secretary for Health/Surgeon General.
"Starting today, every doctor, nurse, health plan, purchaser, and
medical school in America should make treating tobacco dependence a top
priority."
The guideline is aimed
at practicing clinicians. Studies have shown that more than 25 percent of
U.S. adults smoke and that 70 percent 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.
"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," said
Michael C. Fiore, MD, MPH, chair of the guideline panel and director of
the Center for Tobacco Research and Intervention at the University of
Wisconsin Medical School in Madison. "In my view, a doctor isn't
providing an appropriate standard of care for his or her 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 Centers for Disease Control and Prevention (CDC) to be more than
$50 billion annually. In addition, the CDC estimate 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 U.S. Public Health
Service that includes: 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; and the
University of Wisconsin Medical School's Center for Tobacco Research and
Intervention. It builds on a smoking cessation guideline first issued by
the government in 1996. In addition, more than 100 organizations are
supporting this effort.
An article by Dr. Fiore
that presents the findings of the updated guideline appears in the June 28
issue of the Journal of the American Medical Association.
Copies of "Treating
Tobacco Use and Dependence: A Clinical Practice Guideline," and a
consumer guide called "You Can Quit Smoking" are select
available by calling 1-800-358-9295 or writing to Publications
Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907-8547. Or, select
http://www.surgeongeneral.gov/tobacco/default.htm
Copies of guidelines can
also be obtained through the CDC’s Office on Smoking Health publications
warehouse at
(770)
488-5705 (press 2 for publications) as soon as they are
available.
For more information,
contact: Harriett V. Bennett, (301) 594-6119; Farah Englert, (301)
594-6372.
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