Smoking Cessation Clinical Practice Guideline Research Articles

Assessment of content, quality and compliance of the STaR mobile application for smoking cessation.

INTRODUCTIONSmoking cessation support with smartphone applications is widely practised, however, quality and novel content is yet to be established. This study examined content, quality and compliance of the STaR (Sihat Tanpa Rokok - Healthy Without Smoking) smartphone application to smoking cessation clinical practice guidelines.METHODSMobile Application Rating Scale (MARS) was applied to assess the quality of the mobile application. A total of 33 compliance assessment criteria were developed, based on the smoking cessation clinical practice guidelines adopted by the Brunei Ministry of Health and used to rate the compliance.RESULTSThe STaR app has an average quality and compliance score. The mean MARS score of 3.31 and a subjective quality score of 2.50 was measured on a 5-point scale (from 1=inadequate to 5=excellent). The application contents that adhere to smoking cessation clinical practice guidelines suggest adequate adherence to the 5A (Ask, Advice, Assess, Assist, Arrange) and 5R motivational interventions (Relevance, Risks, Rewards, Roadblocks, Repetition) approach for smoking cessation.CONCLUSIONSThe STaR mobile app with the integration of all components of smoking cessation clinical practice guidelines (such as 5A approach and pharmacotherapy intervention) may improve quality scores.

Willingness of tobacco smokers to contribute financially towards cessation resources : correspondence

Exposure to tobacco smoke accounts for approximately 9% (95% confidence interval 8.1 - 10.2) of all South African (SA) deaths. Seventeen percent of SA adults are self-reported active smokers and an alarming 32% of pregnant women were found to be active smokers on urine cotinine testing. Despite the publication in 2013 of the South African Tobacco Smoking Cessation Clinical Practice Guideline, tobacco smoking cessation programmes in the public health sector remain scarce.

Environmental Factors Influencing Adoption of Canadian Guidelines on Smoking Cessation in Dental Healthcare Settings in Quebec: A Qualitative Study of Dentists' Perspectives.

Background: This study aimed to understand dentists’ perspective of the environmental determinants which positively or negatively influence the implementation of Canadian smoking cessation clinical practice guidelines (5As: Ask-Advise-Assess-Assist-Arrange) in private dental clinics in Quebec. Methods: This study used a qualitative design and an integrative conceptual framework composed of three theoretical perspectives. Data collection was conducted in individual semi-directed interviews with 20 private dentists lasting between 35 and 45 min. The audio-recorded data were transcribed verbatim, followed by a directed content analysis. Results: Some of the barriers identified to counselling in smoking cessation were lack of time, patient attitude, lack of prescription of nicotine replacement therapies, lack of reimbursement, and the lack of training of the dental team. Enablers cited by participants were the style of dentist’s leadership, the availability of community, human and material resources, the perception of counselling as a professional duty, and the culture of dental medicine. In addition to these variables, dentists’ attitude and behaviour were affected by different organisations giving initial or continual training to dentists, governmental policies, and the compatibility of Canadian smoking cessation guidelines with the practice of dentistry. Conclusion: Our findings will inform the development of smoking cessation interventions in dental healthcare settings.

South African tobacco smoking cessation clinical practice guideline

Tobacco smoking (i.e. cigarettes, rolled tobacco, pipes, etc.) is associated with significant health risks, reduced life expectancy and negative personal and societal economic impact. Smokers have an increased risk of cancer (i.e. lung, throat, bladder), chronic obstructive pulmonary disease (COPD), tuberculosis and cardiovascular disease (i.e. stroke, heart attack). Smoking affects unborn babies, children and others exposed to second hand smoke. Stopping or 'quitting' is not easy. Nicotine is highly addictive and smoking is frequently associated with social activities (e.g. drinking, eating) or psychological factors (e.g. work pressure, concerns about body weight, anxiety or depressed mood). The benefits of quitting, however, are almost immediate, with a rapid lowering of blood pressure and heart rate, improved taste and smell, and a longer-term reduction in risk of cancer, heart attack and COPD. Successful quitting requires attention to both the factors surrounding why an individual smokes (e.g. stress, depression, habit, etc.) and the symptoms associated with nicotine withdrawal. Many smokers are not ready or willing to quit and require frequent motivational input outlining the benefits that would accrue. In addition to an evaluation of nicotine dependence, co-existent medical or psychiatric conditions and barriers to quitting should be identified. A tailored approach encompassing psychological and social support, in addition to appropriate medication to reduce nicotine withdrawal, is likely to provide the best chance of success. Relapse is not uncommon and reasons for failure should be addressed in a positive manner and further attempts initiated when the individual is ready.Key steps in smoking cessation include: (i) identifying all smokers, alerting them to the harms of smoking and benefits of quitting; (ii) assessing readiness to initiate an attempt to quit; (iii) assessing the physical and psychological dependence to nicotine and smoking; (iv) determining the best combination of counselling/support and pharmacological therapy; (v) setting a quit date and provide suitable resources and support; (vi) frequent follow-up as often as possible via text/telephone or in person; (vii) monitoring for side-effects, relapse and on-going cessation; and (viii) if relapse occurs, providing the necessary support and encourage a further attempt when appropriate.

Vliyanie tabakokureniya na zdorov'e i massu telacheloveka

Tobacco smoking causes a lot of human deseases and is one of the main reasons of premature death. Smoking cessation is very important for the patient's health but difficult for them due to development of nicotine dependence. Tobacco dependence is a chronic disease. Smoking Cessation Clinical Practice Guideline, published in 2008, emphasize the dire health consequences of tobacco dependence, regulate the way of treating patients who want to quit smoking, recommending the use of effective treatments, including counseling and medications. Seven first-line medications (5 nicotine and 2 non-nicotine, including Varenicline) that reliably increase long-term smoking abstinence rates are now available. Smoking cessation is accompanied by a moderate weigh gain. And its a strong motivational factor to continue smoking, espcially for women. Сounseling, healthy food and physical activity are recommended for such patients.

Socioeconomic disparity in provider-delivered assistance to quit smoking

The U.S. Public Health Service smoking cessation clinical practice guideline is the accepted gold standard for smoking cessation treatment. It offers evidence-based treatment recommendations for all clinicians to deliver to all patients at each visit. Despite the release of the guideline and the publication of Healthy People 2010, health care providers still may not appropriately counsel patients to quit smoking. Furthermore, disparities may exist among smokers who are assisted to quit smoking by their health care providers. The present study tested for an association between selected sociodemographic and tobacco-related factors and assistance to quit smoking. This 2001 National Health Interview Survey secondary analysis included a U.S. civilian, noninstitutionalized population. Participants were self-reported current smokers who visited a health care provider in the past 12 months and were at least 25 years old. The outcome measure was smokers' self-report of whether assistance to quit smoking was given by a health care provider. Of smokers who received advice (N = 3,046), only 38% received assistance to quit smoking. Smokers were less likely to report assistance to quit smoking if they were younger or Black, or if they had a high or middle level of socioeconomic disadvantage. In the final logistic regression model, being married, attempting to quit in the past 12 months, and consuming more tobacco were associated with receiving assistance to quit smoking. Increased age also was associated with receiving assistance, as was greater socioeconomic advantage (higher education, higher income, health insurance). The mechanisms responsible for the disparities in delivery of tobacco dependence treatment must be investigated further.

Effectiveness of Implementing the Agency for Healthcare Research and Quality Smoking Cessation Clinical Practice Guideline: A Randomized, Controlled Trial

Effectiveness of Implementing the Agency for Healthcare Research and Quality Smoking Cessation Clinical Practice Guideline: A Randomized, Controlled Trial

Effectiveness of Implementing the Agency for Healthcare Research and Quality Smoking Cessation Clinical Practice Guideline: A Randomized, Controlled Trial

Effectiveness of Implementing the Agency for Healthcare Research and Quality Smoking Cessation Clinical Practice Guideline: A Randomized, Controlled Trial

Implementing guidelines for smoking cessationComparing the efforts of nurses and medical assistants

Background It is unclear how different types of intake clinicians (registered nurses [RNs], and less costly licensed practical nurses [LPNs] and medical assistants [MAs]) compare in the performance of smoking-cessation activities recommended in the Agency for Healthcare Research and Quality (AHRQ) smoking-cessation clinical practice guideline. Methods A secondary analysis of data from a randomized controlled trial of guideline implementation was performed. Exit interviews of consecutive adult smokers who presented to nine primary care clinics for routine, non-emergency care were conducted during the period February 2000 to May 2001; a total of 1221 patients with adequate data were analyzed. Intake clinicians were surveyed prior to guideline training. Hierarchical logistic regression models were used to determine the association between type of intake clinician and performance of cessation counseling at the clinic visit, after adjustment for patient-level covariates, intake clinicians' characteristics, and study site. Results Performance of all guideline-recommended counseling activities were significantly greater for all intake clinicians at test versus control sites. MAs were significantly less likely to assess willingness to quit (adjusted odds ratio [AOR]=0.4, 95% confidence interval [CI]=0.2–0.8, p =0.005) and tended to offer advice and assistance in quitting less often than RNs. Similar findings were observed for LPNs (AOR=0.5, 95% CI=0.3–1.0, p =0.03, for assessing willingness to quit). Subset analysis in subjects with complete survey data revealed that being seen by a MA was no longer associated with statistically significant differences in performance, after accounting for personal beliefs, self-efficacy, and role satisfaction in cessation counseling. Conclusions Although both MAs and LPNs showed marked improvements in performance in response to the guideline intervention, patients seen by these intake clinicians were less likely to receive guideline-recommended counseling, compared to those patients seen by RNs. Given their important role in the delivery of preventive care, MAs and LPNs should receive proper training in cessation counseling, should have strong physician and administrative support, and should be included in efforts to implement smoking-cessation guidelines in primary care. It is unclear how different types of intake clinicians (registered nurses [RNs], and less costly licensed practical nurses [LPNs] and medical assistants [MAs]) compare in the performance of smoking-cessation activities recommended in the Agency for Healthcare Research and Quality (AHRQ) smoking-cessation clinical practice guideline. A secondary analysis of data from a randomized controlled trial of guideline implementation was performed. Exit interviews of consecutive adult smokers who presented to nine primary care clinics for routine, non-emergency care were conducted during the period February 2000 to May 2001; a total of 1221 patients with adequate data were analyzed. Intake clinicians were surveyed prior to guideline training. Hierarchical logistic regression models were used to determine the association between type of intake clinician and performance of cessation counseling at the clinic visit, after adjustment for patient-level covariates, intake clinicians' characteristics, and study site. Performance of all guideline-recommended counseling activities were significantly greater for all intake clinicians at test versus control sites. MAs were significantly less likely to assess willingness to quit (adjusted odds ratio [AOR]=0.4, 95% confidence interval [CI]=0.2–0.8, p =0.005) and tended to offer advice and assistance in quitting less often than RNs. Similar findings were observed for LPNs (AOR=0.5, 95% CI=0.3–1.0, p =0.03, for assessing willingness to quit). Subset analysis in subjects with complete survey data revealed that being seen by a MA was no longer associated with statistically significant differences in performance, after accounting for personal beliefs, self-efficacy, and role satisfaction in cessation counseling. Although both MAs and LPNs showed marked improvements in performance in response to the guideline intervention, patients seen by these intake clinicians were less likely to receive guideline-recommended counseling, compared to those patients seen by RNs. Given their important role in the delivery of preventive care, MAs and LPNs should receive proper training in cessation counseling, should have strong physician and administrative support, and should be included in efforts to implement smoking-cessation guidelines in primary care.

Implementing guidelines for smoking cessation: Comparing the efforts of nurses and medical assistants

It is unclear how different types of intake clinicians (registered nurses [RNs], and less costly licensed practical nurses [LPNs] and medical assistants [MAs]) compare in the performance of smoking-cessation activities recommended in the Agency for Healthcare Research and Quality (AHRQ) smoking-cessation clinical practice guideline. A secondary analysis of data from a randomized controlled trial of guideline implementation was performed. Exit interviews of consecutive adult smokers who presented to nine primary care clinics for routine, non-emergency care were conducted during the period February 2000 to May 2001; a total of 1221 patients with adequate data were analyzed. Intake clinicians were surveyed prior to guideline training. Hierarchical logistic regression models were used to determine the association between type of intake clinician and performance of cessation counseling at the clinic visit, after adjustment for patient-level covariates, intake clinicians' characteristics, and study site. Performance of all guideline-recommended counseling activities were significantly greater for all intake clinicians at test versus control sites. MAs were significantly less likely to assess willingness to quit (adjusted odds ratio [AOR]=0.4, 95% confidence interval [CI]=0.2-0.8, p =0.005) and tended to offer advice and assistance in quitting less often than RNs. Similar findings were observed for LPNs (AOR=0.5, 95% CI=0.3-1.0, p =0.03, for assessing willingness to quit). Subset analysis in subjects with complete survey data revealed that being seen by a MA was no longer associated with statistically significant differences in performance, after accounting for personal beliefs, self-efficacy, and role satisfaction in cessation counseling. Although both MAs and LPNs showed marked improvements in performance in response to the guideline intervention, patients seen by these intake clinicians were less likely to receive guideline-recommended counseling, compared to those patients seen by RNs. Given their important role in the delivery of preventive care, MAs and LPNs should receive proper training in cessation counseling, should have strong physician and administrative support, and should be included in efforts to implement smoking-cessation guidelines in primary care.

The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines

Background This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes. Methods Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions “control” (distribution of printed versions of smoking cessation guidelines) and “incentive” (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system (″registry″). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients’ smoking cessation behaviors. Results Patients’ tobacco use status was statistically significant ( P < 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often ( P < 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions. Conclusions The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.

Effectiveness of a nationally implemented smoking cessation guideline on provider and patient practices

Background The Agency for Health Care Policy and Research (AHCPR) smoking cessation guideline outlines a set of recommendations for physicians to follow in daily practice. However, the effectiveness of this guideline has not been reported. The goal of this project was to evaluate the effect of the AHCPR smoking cessation guideline on provider practices with smokers and on patient smoking rates. Methods Patient survey and chart review data from 138 Veterans Administration (VA) acute care medical centers with outpatient facilities were examined. Data were available from both sources in 1996, 1997, and 1998. At the midpoint of this period (1997), the VA recommended the AHCPR smoking cessation clinical practice guideline for implementation throughout the VA healthcare system. Results From 1996 to 1998, both the chart audit and the patient survey showed a significant increase in the percentage of patients in the VA who were counseled about smoking and a significant decrease in the percentage of patients who smoke. Conclusions Because the VA tied the guideline implementation to report cards and other performance-enhancing measures, guideline adherence may have been maximized in this setting. These findings suggest that healthcare systems should take an integrated approach to guideline implementation.

Dissemination of the AHCPR clinical practice guideline in community health centres

Objective: To evaluate dissemination of the Agency for Health Care Policy and Research (AHCPR) Smoking cessation clinical practice guideline in community health centres. Design: Pre- and post-trial. Setting: Fourteen community...

THE AGENCY FOR HEALTH CARE POLICY AND RESEARCH SMOKING CESSATION CLINICAL PRACTICE GUIDELINE: Basics and Beyond

The 1996 Agency for Health Care Policy and Research's Smoking Cessation Clinical Practice Guideline provides a strong empirical foundation for effective smoking cessation interventions in primary care. Screening all patients for tobacco use status at each clinic visit and providing at least brief cessation advice to all smokers can have a significant system-wide effect. Adding additional treatment components, such as pharmacotherapy, problem solving, and social support, can increase quit rates by twofold or more. Information on effective and ineffective treatment components is provided, along with new information published after the release of the Guideline.

The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline: Findings and implications for psychologists.

Smoking is the leading cause of preventable morbidity and mortality in the United States, and the health benefits of quitting smoking are substantial. Nevertheless, over 25% of American adults (48 million individuals) continue to smoke, and the vast majority of quit attempts are unsuccessful. The Agency for Health Care Policy and Research recently addressed the smoking problem by conducting a 2-year research project that was published as the Smoking Cessation Clinical Practice Guideline (Fiore et al., 1996). This article reviews methods, analyses, and results from the Guideline project, and highlights major Guideline recommendations. Guideline findings and recommendations are discussed with respect to their implications for psychology.

Achieving Smoking Cessation in Nicotine-Dependent Individuals

This article provides guidelines on the treatment of nicotine dependence and tobacco addiction that are based on the recent US Agency for Health Care Policy and Research (AHCPR) Smoking Cessation Clinical Practice Guideline. Nicotine replacement therapy should be encouraged for most patients in the absence of specific contraindications, as it has been shown to be efficacious in increasing abstinence rates in smoking cessation. Although 4 types of nicotine replacement therapy (transdermal patch, polacrilex chewing gum, spray and inhaler) have been shown to be effective, the transdermal nicotine patch is associated with fewer patient compliance problems and/or adverse effects. Clinician-provided social support and skills-training/problem-solving techniques are also effective components of smoking cessation treatment. Smoking cessation interventions of this type that are as brief as 3 minutes are effective in producing both short and long term abstinence, although rates of quitting are higher with more frequent and intensive treatments.

Addiction specialists and the AHCPR Smoking Cessation Clinical Practice Guideline

Addiction specialists and the AHCPR <i>Smoking Cessation Clinical Practice Guideline</i>

Addiction specialists and the AHCPR Smoking Cessation Clinical Practice Guideline

Addiction specialists and the AHCPR Smoking Cessation Clinical Practice Guideline

Smoking Cessation 2: Components of Effective Intervention

Smoking cessation treatment is an essential component of comprehensive healthcare, but many healthcare providers lack formal training and are hesitant to provide such intervention. The recently published US Agency for Health Care Policy and Research (AHCPR) Smoking Cessation Clinical Practice Guideline provided epmpirically based recommendations to address these issues. The most effective components of smoking cessation include the use of nicotine replacement therapy, provider support and encouragement, and training in such skills as problem solving and coping. Methods of using these recommendations are illustrated, and sample scripts are offered to serve as references for providers from various disciplines who conduct smoking cessation interventions.

Current approaches in smoking cessation.

This review highlights the necessity of smoking cessation as a cornerstone of cancer prevention. We briefly review the literature linking smoking to various forms of cancer, the benefits of smoking cessation for cancer patients, and the Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline. Also provided is an update on controlled smoking cessation studies published between March 1995 and February 1996.