Journal of Family Practice - What are the most effective ways you can help patients stop smoking?
Evidence-based answer
Brief counseling, nicotine replacement therapy, antidepressants, and varenicline all work well. Physician intervention should begin with routine assessment of smoking status for all patients. Brief (3 minutes or less) smoking cessation counseling improves quit rates (strength of recommendation [SOR]: A, Cochrane systematic review). Nicotine replacement therapy (NRT), antidepressants (bupropion and nortriptyline), and the nicotine receptor partial agonist varenicline are effective and should be offered to help smokers quit (SOR: A, Cochrane systematic reviews and randomized controlled trials [RCTs]).
Clinical commentary
Ask and act
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Physician counseling can help patients stop using tobacco. Medications, including NRT, increase abstinence rates even more. I find the American Academy of Family Physicians’ smoking cessation program, “Ask and Act,” easier to use than the United States Public Health Services “5 A’s” approach, which is described later in this Clinical Inquiry.
Several materials that support the Ask and Act program are available free online at www.aafp.org (click on “Ask and Act” under “Clinical Care & Research”). I have used the prescription sheet for smoking cessation when talking to patients about quitting; the coding reference gives some guidance about charging for cessation counseling. A prescribing guideline for medications, including side effects and contraindications, is also available.
Julia Fashner, MD
St. Joseph Regional Medical Center, South Bend, Ind
* Evidence summary
Brief counseling works
Good evidence suggests that physician-administered smoking cessation counseling lasting less than 3 minutes improves quit rates. (1) A Cochrane analysis of pooled data from 17 randomized trials that compared brief advice to no advice or usual care showed a small but significant increase in the odds of smoking cessation (odds ratio [OR]=1.74; 95% confidence interval [CI], 1.48-2.05). (2) The absolute difference in cessation rate was about 2.5% (number needed to treat [NNT]=40).
Another systematic review of 188 RCTs concluded that an estimated 2% (95% CI, 1%-3%; P
