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Set Your Quit Date. The first step to becoming smokefree is to choose when you want to quit.
Risks: Patient identifies potential negative consequences of continued smoking. Rewards: Patient describes how quitting would benefit her and her family. Roadblocks: Patient identifies barriers to quitting. Repetition: Repeat at every visit for patients who smoke.
When counseling your patients about smoking, the Agency for Healthcare Research recommends a brief smoking cessation intervention known as the "5 A's": Ask, Advise, Assess, Assist, and Arrange.ASSIST.Capitalize on teachable moments to discuss healthy lifestyle choices.
EVIDENCE-BASED ANSWER Among pharmacotherapy options, dual nicotine replacement therapy (NRT) and varenicline (Chantix) are equally effective for smoking cessation at six months and more effective than single NRT and bupropion (SOR A, meta-analysis of RCTs).
The options include:Prescription nicotine in a nasal spray or inhaler.Over-the-counter nicotine patches, gum and lozenges.Prescription non-nicotine stop-smoking medications such as bupropion (Zyban) and varenicline (Chantix)
Initial therapy selection First-line pharmacotherapies for smoking cessation include nicotine replacement therapy (NRT), varenicline, and bupropion (table 1) 1,2,7-9. These treatments aim to reduce symptoms of nicotine withdrawal, thereby making it easier to stop using cigarettes.
Successful intervention begins with identifying users and appropriate interventions based upon the patient's willingness to quit. The five major steps to intervention are the "5 A's": Ask, Advise, Assess, Assist, and Arrange. Ask - Identify and document tobacco use status for every patient at every visit.
Call 1-800-QUIT-NOW (784-8669) or visit Quit Partner.
The Ottawa Model for Smoking Cessation in 120 hospitals across Canada identifies the smoking status of all admitted patients, followed by brief advice, personalised bedside counselling, timely nicotine replacement therapy and/or pharmacotherapy, and follow-up after discharge 27.
5 Stages to QuittingPre-contemplation (not thinking about quitting)Contemplation (thinking about quitting but not ready to quit)Preparation (getting ready to quit)Action (quitting)Maintenance (remaining a non-smoker)