Treatment
from Physicians Can Double Quit Rates
Dr.
Tom Jackson chuckles when he hears about health care providers
who are reluctant to ask patients about their tobacco use.
“I doubt
we would be reluctant to take someone’s blood pressure if
we knew he or she had high blood pressure,” Jackson says.
“In the ‘60s, doctors didn’t want to tackle
hypertension. It took 15 years to get everyone on board. We need
to treat smoking as an illness, like hypertension.”
Jackson, a University
of Wisconsin Medical School professor who practices medicine at the
Adult Primary Care Clinic at Aurora Sinai Hospital, has taken a keen
interest in smoking cessation because tobacco use is the leading cause
of preventable death in the United States. Tobacco kills approximately 440,000
people every year, including 7,350 in Wisconsin. That’s more than
the combined death rates for AIDS, drugs, alcohol, homicide, suicide
and motor vehicle accidents, according to the Centers for Disease Control. |
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Tom Jackson, M.D., Aurora HealthCare
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Yet many providers
are skittish about asking patients if they use tobacco or advising them
about the dangers, citing a variety of factors – including time
and a fear that patients will become upset.
Boost
Your Patient Satisfaction Ratings
Jackson says patient satisfaction ratings actually go up, not down,
when the physician asks about smoking habits. “The patient sees
that you care about his or her health,” he says.
According to a study
just published in Preventive Medicine, 68 percent of smokers who were
offered free cessation treatment at their regular clinics took advantage
of the invitation. Jackson was a key investigator on the study.
Nancy Kojis, a registered
nurse from Aurora’s clinic on Silver Spring Drive, says most patients
really appreciate it when providers ask about tobacco use and provide
helpful information, such as a referral to the Wisconsin Tobacco Quit
Line.
“We use the
Quit Line and love it,” Kojis says. “We get a lot of patients
who quit and say, ‘I’m glad you gave me the number for the
Quit Line.’” Smokers can contact the Quit Line by calling
(877) 270-STOP.
Kojis says some
patients have asked why Aurora does tobacco intervention. “We
tell them, ‘Well, because we’re trying to keep you healthy,’”
Kojis says. Her clinic has had success asking almost every patient about
tobacco use at every visit.
Small
Investment, Big Gain
Research shows smokers’ chances of quitting double when a physician
offers intervention and support. So while it may seem like an interruption
to ask about tobacco use, not doing so increases the chances you’ll
see the patient again for a serious illness caused by tobacco use.
“Smoking is
probably as important as any other health issue you’re treating
that day,” Jackson says.
It only takes Jackson
approximately three to four minutes to interact with a patient about
smoking because he has educational materials ready to give the patient
and a streamlined documentation system for the physician, nurse or medical
assistant handling the discussion.
“We have quick,
effective intervention tools available,” Jackson says. Jackson
bases his tobacco treatment on the Clinical Practice Guideline: Treating
Tobacco Use and Dependence, a document produced by the U.S. Department
of Heath and Human Services. Get your copy by visiting the Surgeon General’s
website, http://www.surgeongeneral.gov/tobacco.
“Every provider
should have the guideline in their office,” Jackson says. The
guideline sites five steps for physicians to treat tobacco dependence,
commonly referred to as the “5 A’s:”
1. Ask about tobacco use (and document results).
2. Advise the patient to quit.
3. Assess the patient’s willingness to make a quit attempt.
4. Assist by:
a. Expressing
your support.
b. Helping the patient set a quit date.
c. Prescribing appropriate nicotine replacement medications.
d. Referring him or her to the Wisconsin Tobacco Quit Line.
5. Arrange follow-up.
“Smoking cessation
is simple; it’s the 5 A’s,” Jackson says. Even if
physicians simply ask about tobacco use and refer smokers to the Quit
Line it can be a significant help, he says.
Some providers say
they’re discouraged to try treating tobacco use because it’s
a chronic health issue. It can take repeated treatment and quit attempts
to help the patient become tobacco-free. Research shows only five percent
of smokers who try to quit on their own (“cold turkey”)
are successful.
But Jackson says
physicians shouldn’t let that daunt them. Quit rates can reach
22 percent or higher with the help of a physician, nicotine replacement
medications and quit line counseling. Jackson says it’s not much
different than treating other chronic illnesses.
“In most cases,
you don’t cure high blood pressure in one visit,” he says.
“Treat smoking as a chronic illness. When you get in that mindset,
it makes it so much easier to deal with. You don’t feel rushed
to treat an acute problem.”
If you have questions
about successfully treating tobacco or would like Dr. Jackson to speak
to a group of medical providers, e-mail him at tjackso1@facstaff.wisc.edu
or call (414) 219-7985.
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