Treatment issues: towards a stepped-care model

Abstract

The winds of change in health care in the US place us on the edge of a decade of opportunity to make a difference in prevention of chronic diseases related to lifestyle. The philosophy that prevention be fully integrated into mainstream health care practice is central to these winds of change. We must ensure the optimisation of health care practice in terms of quality of life, quality of services, access, and cost for all citizens. This presentation focuses on the essential elements to be considered in making wise choices about comprehensive treatment of tobacco dependence. My goals for this presentation are threefold: First, I will highlight general conceptual principles. Second, I will provide specific recommendations for optimal treatment of tobacco dependence using a stepped-care approach. Third, I conclude with an exploration of selected concerns about barriers to treatment implementation, service delivery, and to standards of care and cost- effectiveness. Even in this age of high technology communications, there’s a natural insularity among disciplines. Insularity in three broad domains has slowed progress toward a comprehensive approach to the treatment of all smokers in the population. The domains are the biological, clinical, and public health sciences. In the biological domain, genetic, biobehavioural science, and neurochemistry research is conducted. Concepts include genetic vulnerability and the key neuroregulatory adaptive mechanisms in tobacco dependence.1,2 In the clinical domain, many treatment programmes and relapse prevention techniques are researched.3,4 They range from nicotine replacement to behaviour modification to hypnosis.5,6 In the public health arena are the more macrodomains of public policy, organisational systems, epidemiology, economics, and health communications/education.7,8 We have to integrate key concepts from all three areas to do justice to a comprehensive treatment approach.9,10 Otherwise, important factors for optimal treatments …