Strategies for Implementing a Tobacco User Identification and Intervention System
within the Healthcare Setting
Establish a Tobacco User Identification System
System-Wide Tobacco Cessation Program for Clinicians
Clinicians: Physicians, pharmacists, nurses, physician's assistants, and other professions working with patients who use tobacco.
Clinicians should identify tobacco users at each visit and intervene with those individuals who are willing to quit (refer to the 5A’s). Tobacco users willing to make a quit attempt should receive both counseling and pharmacotherapy, except in the presence of special circumstances.
For patients not willing to make a quit attempt now, clinicians should motivate the patient to consider quitting (use the 5Rs).
Why it is important to use a system in the treatment of tobacco use.
1) The human cost of tobacco use is devastating.
Tobacco is the single greatest cause of disease and premature death in America today and is responsible for more than 430,000 deaths each year. Nearly 25 percent of adult Americans currently smoke, and 3,000 children and adolescents become regular users of tobacco every day.
2) The financial burden of tobacco use is staggering.
The societal costs of tobacco death and disease approach $100 billion. Americans spend an estimated $50 billion annually on direct medical care for smoking-related illnesses. Lost productivity and forfeited earnings due to smoking-related disability account for another $47 billion per year.
According to Treatment Tobacco Use And Dependence (view chart),
a clinical practice guideline released in June 2000 by the U.S. Public Health Service (PHS), efficacious cessation treatments for tobacco users are available and should become a part of standard caregiving. In addition, research shows that delivering treatment to tobacco users is cost-effective. Smoking cessation interventions are less costly than other routine medical interventions such as treatment of mild to moderate high blood pressure and preventive medical practices such as periodic mammography. In fact, the average cost per smoker for effective cessation treatment is $165.61.
It is important for clinicians and health care delivery systems to instututionalize the consistent indentification, documentation, and treatment of every tobacco user seen in a health care setting so that smoking cessation intervention can influence a large number of tobacco users. Clinicians and health care delivery systems should take the responsibility to craft policies, provide resources, and display leadership that results in consistent and effective tobacco use treatment.
Strategies to ensure that institutional changes in promoting tobacco dependence treatment are implemented universally and systematically
• Every clinic should implement a tobacco-user identification system.
• All health care systems should provide education, resources, and feedback to promote provider interventions.
• Clinical sites should dedicate staff to provide tobacco dependence treatment and assess the delivery of this treatment in staff performance evaluations.
• Hospitals should promote policies that support and provide tobacco dependence services.
Links to printable diagrams:
 |
Diagram #1 - Implement a tobacco-user identification system in every clinic. |
 |
Diagram #2 - Provide education, resources, and feedback to promote provider intervention. |
 |
Diagram #3 - Dedicate staff to provide tobacco dependence and assess the delivery of this treatment in staff performance evaluations. |
 |
Diagram #4 - Promote hospital policies that support and provide inpatient tobacco dependence services. |
All tobacco users have the potential to successfully quit, and every clinician should commit to delivering treatment that can help.
