Maximizing smoking cessation in clinical practice: pharmacologic and behavioral interventions.
Clinicians are in a unique position to reduce cardiovascular morbidity and mortality by helping their patients quit smoking. At each visit, clinicians should document smoking status, provide strong and clear advice to quit, and recommend and prescribe pharmacotherapy for patients who are motivated to quit, which can double the odds of success. Effective pharmacotherapies include nicotine replacement, bupropion, and varenicline, which was recently approved by the Food and Drug Administration. Behavioral counseling to develop a quit plan and extended follow-up are critical to maximize quit rates but are rarely provided by clinicians due to time constraints and lack of expertise. As an alternative, the authors recommend referral to telephone quitlines that provide no-cost behavioral counseling by specialists. Hospitals should implement systemwide procedures to ensure that smokers are identified at admission and trained staff is available to provide smoking cessation consults that include a minimum of 20 minutes of inpatient counseling with follow-up for at least 1 month.
Nides
Mitchell
M
Los Angeles Clinical Trails, Los Angeles, CA 90025, USA. mnides@laclinicaltrails.com
Leischow
Scott
S
Sarna
Linda
L
Evans
Sarah E
SE
D001521:Behavior Therapy; D001552:Benzazepines / Q000627:therapeutic use; D016642:Bupropion / Q000627:therapeutic use; D003131:Combined Modality Therapy; D037001:Directive Counseling; D006760:Hospitalization; D006801:Humans; D020407:Internet; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D011810:Quinoxalines / Q000627:therapeutic use; D011978:Receptors, Nicotinic / Q000187:drug effects; D040242:Risk Reduction Behavior; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000628:therapy*; D000068580:Varenicline
D001552:Benzazepines; D011810:Quinoxalines; D011978:Receptors, Nicotinic; D016642:Bupropion; D000068580:Varenicline