The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline
- Smoking Cessation Clinical Practice Guideline Panel and Staff;
- Michael C. Fiore, MD, MPH;
- David W. Wetter, PhD;
- William C. Bailey, MD;
- Glen Bennett, MPH;
- Stuart J. Cohen, EdD;
- Sally Faith Dorfman, MD, MSHSA;
- Michael G. Goldstein, MD;
- Ellen R. Gritz, PhD;
- Victor Hasselblad, PhD;
- Jack E. Henningfield, PhD;
- Richard B. Heyman, MD;
- John Holbrook, MD;
- Corinne Husten, MD, MPH;
- Carlos Roberto Jaen, MD, PhD;
- Connie Kohler, DrPH;
- Thomas E. Kottke, MD, MSPH;
- Harry A. Lando, PhD;
- Marc Manley, MD, MPH;
- Robert Mecklenburg, DDS, MPH;
- Cathy Melvin, PhD, MPH;
- Patricia Dolan Mullen, DrPH;
- Louise M. Nett, RN, RRT;
- Thomas M. Piasecki, MS;
- Lawrence Robinson, MD, MPH;
- Debra Rothstein, PhD;
- David L. Schriger, MD, MPH;
- Maxine L. Stitzer, PhD;
- Sylvie Stachenko, MD, MSC, FCFP;
- Anthony Tommasello, MS;
- Louise Villejo, MPH, CHES;
- Mary Ellen Wewers, PhD, RN;
- Timothy B. Baker, PhD
- Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison; University of Texas M. D. Anderson Cancer Center, Houston; University of Alabama at Birmingham; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; Bowman Gray School of Medicine,; Winston-Salem, NC; Cornwall, NY; The Miriam Hospital, Brown University School of Medicine, Providence, RI; University of Texas M. D. Anderson Cancer Center, Houston; Duke University, Durham, NC; National Institute on Drug Abuse, National Institutes of Health, Baltimore, Md; American Academy of Pediatrics, Cincinnati, Ohio; University of Utah School of Medicine, Salt Lake City; Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Ga; Center for Urban Research in Primary Care, State University of New York at Buffalo; University of Alabama at Birmingham; Mayo Clinic and Foundation, Rochester, Minn; University of Minnesota, Minneapolis; National Cancer Institute, National Institutes of Health, Rockville, Md; National Cancer Institute, Potomac, Md; Centers for Disease Control and Prevention, Atlanta, Ga; Center for Health Promotion Research and Development, University of Texas, Houston; PSL/Health ONE, Center for Health Science Studies, Denver, Colo; Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison; Philadelphia (Pa) Department of Public Health; Office on Disease Prevention and Health Promotion, Washington, DC; UCLA School of Medicine, Los Angeles, Calif; Johns Hopkins/ Bayview Medical Center, Baltimore, Md; Health Canada, Ottawa, Ontario; University of Maryland at Baltimore School of Pharmacy; University of Texas M. D. Anderson Cancer Center, Houston; College of Nursing, Ohio State University, Columbus; Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison
Abstract
Objective. —To summarize the Smoking Cessation Clinical Practice Guideline that provides recommendations for 3 groups of professionals: primary care clinicians, smoking cessation specialists, and health care administrators, insurers, and purchasers.
Participants. —An independent panel of scientists, clinicians, consumers, and methodologists selected by the US Agency for Health Care Policy and Research.
Evidence. —English-language, peer-reviewed literature published between 1975 and 1994 that addresses the assessment and treatment of tobacco dependence, nicotine addiction, and clinical practice.
Consensus Process. —Four panel meetings were held over 2 years to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. The Guideline was repeatedly reviewed and revised.
Conclusions. —The panel recommendations address 3 audiences. Major recommendations for primary care clinicians are to use officewide systems to identify smokers, treat every smoker with a cessation or motivational intervention, offer nicotine replacement except in special circumstances, and schedule follow-up contact to occur after cessation. Major recommendations to smoking cessation specialists are to use multiple individual or group counseling sessions lasting at least 20 minutes each with sessions spanning multiple weeks, offer nicotine replacement, and provide problem-solving and social support counseling. Major recommendations for health care administrators, insurers, and purchasers are that tobacco-user identification systems be used in all clinics and that smoking cessation treatment be supported through staff education and training, dedicated staff, changes in hospital policies, and the provision of reimbursement for tobaccodependence treatment.
(JAMA. 1996;275:1270-1280)
Footnotes
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A complete list of the members of the Smoking Cessation Clinical Practice Guideline Panel and Staff appears at the end of this article.
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Drs Fiore and Baker have worked on clinical research studies funded in part by ALZA Corporation, CIBA-Geigy Corporation, Elan Pharmaceutical, Lederle Laboratories, and Marion Merrell Dow, Inc. Dr Goldstein has received research support from BristolMyers Squibb Company, Glaxo Wellcome, Dupont Merck, Eli Lilly, and Boehringer Ingelheim and is a member of the speaker's bureau for Bristol-Myers Squibb and Pfizer, Inc. Dr Henningfield is a consultant to Corporate Health Policies Group, which consults to the pharmaceutical industry on nicotine replacement products.
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Reprints: Michael C. Fiore, MD, MPH, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, 1300 University Ave, Madison, WI 53706.
