Better efforts sought for quitting smoking
■ Reminders, assessment and feedback for doctors have helped get smokers to quit; experts say this work is ready to move to the next level.
By Victoria Stagg Elliott — Posted May 23, 2005
A multipronged system-based approach to smoking cessation increases quit rates among patients, but such efforts must become more integrated into other disease management systems to avoid overloading doctors, according to a panel discussion earlier this month at the Addressing Tobacco in Managed Care meeting in Chicago.
For example, advocates lobbied against one more disease management program for smoking, particularly because many patients are in more that one such program already.
"We do piecemeal medical care and fragment it way too much," said American Medical Association trustee Ronald M. Davis, MD, during his presentation. Over the past decade, managed care organizations increasingly have experimented with ways to bolster physician involvement in smoking cessation. These have included mechanisms to make notes of smoking status in medical records, to provide physician reminders to discuss cessation with known tobacco users and to give feedback to doctors on anti-tobacco efforts.
Attendees said these efforts needed to become higher quality rather than more numerous and recommended that physician offices be linked to quit lines. Discussions also should focus on cessation as a process rather than a single event.
"We need to make it less frustrating for practices to deal with their smokers," said Susan Swartz, MD, MPH, medical director of the Center for Tobacco Independence at Maine Medical Center in Portland.
Reducing tobacco use has long been a focus of organized medicine. The AMA has policies encouraging doctors to ask at every visit if their patients smoke and carry out a brief intervention for those who do. Doctors and patients also are encouraged to become aware of smoking cessation programs in their communities.