Treatment from Physicians Can Double Quit Rates

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.