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Smoking cessation: Brief interventions work
Attracting smokers into treatment is vital
Have information at your fingertips
Every healthcare professional has sources Page 24) copied and at your fin- ments are available to them.
gertips to pass on to your patients.
about their previous attempts to quit.
diction is, attracting patients into treat- the last time you tried?” Recent quit at- a brief intervention format, treating to- clinical encounter in just two- to three- patches, cold turkey, quit lines or selfhelp initiatives? Find out how these 1. Determine stage of change and
motivation to quit
The format for brief interventions
involves the following five steps:
are you using now?” The intent of these Organize to promote cessation
tients who score less than 7 are less suc- rettes used per day and the time it takes patients to have their first cigarette. In Identify patients
insignificant but it is a key first step.
results in a three-fold increase in coun- 2.Collect a history of quit attempts
Some people have never tried to quit.
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3.Provide NRT suggestions
Collect history of quit attempts
issue, be sure to calculate the long-term no hard and fast rules but, in general, if Provide NRT suggestions
haler spray, bupropion or varenicline.
perts feel that tailoring treatment to the cents, if behavior therapy is not able to ed, a spray,or an inhaler. Zyban’s rating exposure is not established, but is being The more convenient the better
compliance
Montalto 15
scale, 1 is not bad at all and 10 is terri- ble. If this score is greater than 5, the tients to use gum, sprays, lozenges or in- Encourage use of supportive behavioral
be more costly, the goal is to quit. Have treatments.
the first four- to six-weeks, start to wean 4.Encourage use of supportive behav-
ioral treatments.
their physicians, should be praised.
out if they still want to quit. Next, find iors to avoid smoking (see Figure 4).
Follow up at next visit
is “free” when the product is purchased.
(cigarettes per day now vs prequit).
5.Follow up at next visit.
Ⅲ Assess withdrawal symptom control.
Guidelines suggest follow-up in the first seven days after the cessation date. This Nicotine Replacement Therapy
Rapid Acting (acute urges or daily use)
up is better than none but more inten-sive face-to-face interventions are more Slower Acting
(daily baseline replacement)
encourage them not to get discouraged.
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NICOTINE WITHDRAWAL SCALE
Quantifying Severity
On a scale of 1 to 10 with 1 being least and 10 being most, have your patients indicate the severity of the following signs.
ncpp). By taking an active role in help-ing smokers quit osteopathic physi- cians can have a dramatic impact onpublic health and the health of the References
1. Fiore MC, Bailey WC, Cohen SJ,etal. Treating Tobacco Use and Depen- dence. Clinical Practice Guideline.
Rockville, MD: US Department of Evaluating and management of your patient’s responses to withdrawal
symptoms. The total number of symptoms over 7 increases the risk of relapse.
Individual Score 1-4
2. O’Loughlin J, Tarasuk J, DiFranza J, Low-level withdrawal: Increase behavioral strategies.
Paradis G. Measurement of nicotine de-pendence: reliability of selected meas- Individual Score 5-6
Additional evaluation needed to determine relapse risk and coping skills.
ures of nicotine dependence among ado-lescents. Ann Epidemiol 2002;12:353-62. Individual Score 7-10
Severe symptom. Use both behavioral and NRT interventions to reduce symptoms.
otti NA, Solberg LI, Gordon N, Ritz-woller D, Smith S, Hu W, Zapka J. To-bacco cessation services and patient Nicotine withdrawal
satisfaction in nine nonprofit HMOs.
events. Total abstinence in the first two weeks carries a high degree of success.
Norman J. Montalto, DO, is the medical visits. Physicians can use 1-to-10 scales director of the West Virginia Tobacco Quit to quantify severity (see Figure 7).
Line and clinical associate professor of Family Medicine at the West Virginia Final notes
School of Medicine. Dr Montalto special- izes in tobacco cessation and serves on the speakers bureau for Pfizer and, Glaxo- Smith Kline. He can be reached via e-mail tivating patients into therapy is our re- Montalto 17

Source: http://www.cecity.com/aoa/whole_patient/apr_07/print8.pdf