The Role of Health Professionals

Why Tobacco Use Treatment Should be a Priority

Seventy percent of smokers visit a physician at least once a year. Tobacco users who receive advice and resources to quit from their provider have higher satisfaction rates. Yet, only half of tobacco users report being advised to quit by a doctor during the past 12 months.¹

According to the Treating Tobacco Use and Dependence: Clinical Practice Guideline, 2008 Update, “busy clinical teams should make the treatment of tobacco use a priority based on the compelling evidence:

• Clinicians can make a difference with even a minimal (less than 3 minutes) intervention;
• A relation exists between the intensity of intervention and tobacco cessation outcome;
• Even when patients are not willing to make a quit attempt at this time, clinician-delivered brief interventions enhance motivation and increase the likelihood of future quit attempts;
• Tobacco users are being primed to consider quitting by a wide range of societal and environmental factors;
• There is growing evidence that smokers who receive clinician advice and assistance with quitting report greater satisfaction with their health care than those who do not;
• Tobacco use interventions are highly cost effective; and
• Tobacco use has a high case fatality rate (up to 50% of long-term smokers will die of a smoking caused disease).”

The Gold Standard for Tobacco Use Intervention

Asking and advising patients to quit are not just good patient care, but can actually double the chance a smoker will make a quit attempt.² According to the Clinical Practice Guideline, the gold standard for tobacco use intervention by health care providers is the “5 A’s” intervention: Ask, Advise, Assess, Assist, and Arrange.

A Team Approach to Tobacco Use Intervention

Providers have not broadly implemented the 5 A’s due to a pervasive belief that they take too much time. Many clinician groups now promote a streamlined version of the intervention, such as “Ask-Advise-Refer”. The goal of the alternate approaches is to increase the likelihood of clinicians intervening by simplifying their task: they Ask and Advise, then hand the patient off to a quitline or other cessation service provider to Assess, Assist, and Arrange. Such efforts have been successful both in changing health care provider behavior and in generating referrals for cessation treatment providers.

1 Danesh D, Paskett ED, Ferketich AK. Disparities in Receipt of Advice to Quit Smoking From Health Care Providers: 2010 National Health Interview Survey. Prev Chronic Dis 2014;11:140053.
2 Kruger, J, Shaw L, Kahende J, Health Care Providers’ Advice to Quit Smoking, National Health Interview Survey, 2000, 2005, and 2010. Preventing Chronic Disease 2012; 11_0340