soonercare coverage for quitting tobacco Cessation OHCA Provider Memo

Chemical characterization and bioactivity of cigarette butt extract as oviposition deterrent and larvicide against Aedes aegypti

The flint rubs onto the wheel when spun with sufficient force and speed, thus creating a spark

The frets are worn but level, and consistent with the larger and flatter '70s and '80s Gibson frets

(positive reinforcement) Tolerance develops (desensitization) Brains chemistry is altered (density of nicotinic receptors in smokers is 100 to 300% higher than nonsmokers) Absence leads to withdrawal symptoms, such as irritability & craving (negative reinforcement) References: 1 & 6 Understanding Tobacco DependenceNICOTINE ADDICTION Smoker needs to repeat dosing during waking hours in order to maintain optimal level of nicotine Reference: 6 Understanding Tobacco DependenceNICOTINE ADDICTION References: 4 & 6 Understanding Tobacco DependenceTOBACCO DEPENDENCE Behavioral, Social and Other Aspects of Tobacco Use & Dependence Satisfaction derived from smoking and/or tobacco use behavior Conditioned responses (triggers) Attachment to the image of being a smoker/tobacco user (marketing influences) Peer, family, social and cultural influences Genetics, gender, comorbidity (medical/psychiatric) References: 3 & 7 Understanding Tobacco DependenceSTAGES OF CHANGE Change seen as a multistage process Success often involves repetitive cycling through of the stages Relapse is a normal part of the process Interventions that match the stage may be more effective The goal is to progress to the next stage Reference: 8 Understanding Tobacco DependenceSTAGES OF CHANGE Goals and Objectives Precontemplation plant a seed, create ambivalence Contemplation tip the scales, decide to change Preparation make a plan, identify and find tools Action begin new behavior (action daily for 1 month) Maintenance persist (new behavior becomes the norm) Relapse recycle back to Preparation & Action References: 7 & 8 Understanding Tobacco DependenceCLINICAL PRACTICE GUIDELINE Smoking Cessation clinical practice guideline published by AHCPR (now AHRQ), April 1996 Based on 3,000 studies published between 1975-1994 Updated Treating Tobacco Use and Dependence guideline published jointly by AHRQ, USPHS and NCI, June 2000 Based on additional 3,000 studies published between 1995-1999 Understanding Tobacco DependenceGUIDELINE KEY FINDINGS Chronic condition, often requires repeated interventions Effective treatments exist, therefore: Every patient should be offered treatment (willing) or brief motivational intervention (unwilling) Essential: institutionalizing consistent identification, documentation and treatment of every tobacco user Understanding Tobacco DependenceGUIDELINE KEY FINDINGS Brief treatment is effective and should be offered to all users (minimum care) Strong dose-response relation between intensity of counseling and effectiveness Three types counseling especially effective: Providing practical counseling Providing intra-treatment support Helping secure extra-treatment support Understanding Tobacco DependenceGUIDELINE KEY FINDINGS Numerous effective pharmacotherapies exist (and should be used unless contraindicated) First-line pharmacotherapies include: Bupropion SR Nicotine gum Nicotine patch Nicotine inhaler Nicotine lozenge Nicotine nasal spray Second-line pharmacotherapies include: Clonidine Nortriptyline Understanding Tobacco DependenceGUIDELINE KEY FINDINGS Treatments are both clinically effective and cost-effective, therefore: Insurers and purchasers should ensure that: Effective treatments (counseling and pharmacotherapy) are included as reimbursed benefits in all insurance plans Clinicians are reimbursed for providing treatment To download the Treating Tobacco Use and Dependence clinical practiceguideline: Reference: 9 Developing a Smoking Cessation Program in the Acute Care Setting How to Implement an Effective Cessation Program Terrina J Thomas, MS, CHES Community Health and Prevention Sentara Healthcare [email protected] How to Implement an Effective Cessation ProgramThe 5 As ASK - systematically identify tobacco use status of EVERY patient ADVISE - urge all tobacco users to quit in a clear, strong and personal way ASSESS - decide the patients willingness to quit (if not willing, implement 5Rs) How to Implement an Effective Cessation ProgramThe 5 As ASSIST - aid willing patients in developing a quit plan: Support Medications Coping/problem-solving skills ARRANGE - schedule for follow-up How to Implement an Effective Cessation ProgramThe 5 Rs RELEVANCE - help make connection to specific personal reasons to stop RISKS - ask patient to identify potential negative consequences of continued tobacco use REWARDS - ask patient to identify potential benefits of tobacco cessation How to Implement an Effective Cessation ProgramThe 5 Rs ROADBLOCKS - ask patient to identify barriers to quitting and make a plan to address them REPETITION - repeat motivational intervention at EVERY encounter How to Implement an Effective Cessation ProgramRelapse Prevention Minimal Practice use open-ended questions and encourage active discussion of successes/problems Prescriptive help patient identify ways to cope with threats: no support, negative mood, withdrawal, weight gain, flagging motivation, etc