Doctors Develop Stop-Smoking Kits New York–Two programs developed to help primary care physicians help their patients quit smoking may contribute to U.S. Surgeon General C. Everett Koop’s goal of a smoke-free society by the year 2000.
A comprehensive stop-smoking kit designed for office use by family physicians is showing early promise as a smoking-cessation tool and could help twice as many patients become ex-smokers, American Academy of Family Physicians president Harry L. Metcalf predicts.
“This is the first time a medical organization has systematically put together a kit to teach doctors how to help their patients stop smoking,” Dr. Metcalf told MWN.
The AAFP agreed in 1985 to work toward Dr. Koop’s goal. “But we thought we needed to give physicians something more to accomplish that,” says Dr. Metcalf, an associate clinical professor of family medicine at the State University of New York of Buffalo. After spending two years and $225,000 in research and design costs, the AAFP began offering the $50 kit to members this January and has received 1,500 requests so far.
Up to 40%. In those few months, Dr. Metcalf says the family physicians in his group practice in Williamsville, N.Y. have started to see good results using the program. “If you just tell patients to stop smoking, 5% may stop after one year. [If you] use behavior modification–and, with highly addicted patients, nicotine gum–maybe 15% succeed. Now we’re looking at a 30% to 40% quit rate with the kit.” The AAFP plans to survey those who have used the kit for their success rates at the end of 1988, he says.
The program takes a comprehensive approach to smoking cessation and combines elements of behavior modification techniques. The physician leans how to counsel patients on preparing to quit and dealing with tempting situations and cravings, and a nicotine dependency quiz helps identify those patients who may need a prescription for nicotine gum.
Physicians need to know “the ABCs of helping smokers quit,” Dr. Steven R. Cummings told internists at a smoking-cessation workshop during the American College of Physicians meeting here last month. “Ask if patients smoke. Boost their motivation to quit. Consider using nicotine gum. Set a date to quit and follow up on it.”
Quit for life. Dr. Cummings’ Quit for Life protocol, designed for physicians to help patients stop smoking, contains many of the same elements as the AAFP program. Physicians should ask questions about smoking as part of a routine office visit, put reminders on smokers’ charts, provide self-help pamphlets to all smokers, and follow up on those who set quit dates, suggests Dr. Cummings, an assistant professor of medicine and epidemiology at the University of California, San Francisco.
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Dr. Cummings emphasized the importance of physicians’ advice. About 10% of smokers advised to quit by their physicians do manage to stay off cigarettes, he says. “Smokers with symptoms of recently diagnosed illnesses attributable to smoking and those with risk factors for smoking-related illnesses may be especially open to physicians’ advice.”
About two-thirds of all smokers say they are interested in quitting if their physician asks, says Dr. Cummings, and about 60% try to quit during the next year. “If they are interested, take the next step.” If they aren’t interested, offer them a pamphlet about the benefits of quitting, he says.
But “don’t force the issue,” Dr. Cummings cautions. “About 30% of these patients will try to quit during the next year. Invite them to call or visit you when they are more interested in quitting.”