Tobacco Cessation

The Centers for Disease Control and Prevention (CDC) says that more deaths are caused each year by tobacco use than from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined. Research confirms that secondhand smoke causes disease and premature death in children and adults who do not smoke.

Tobacco Cessation

Tobacco Use and Dependence – CareOregon Approved Guidelines

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Brief Clinical Strategies for Patients Willing To Quit (Five A's)

 

Ask about tobacco use. Identify and document tobacco use status for every patient at every visit. (Brief Strategy A1)
Advise to quit. In a clear, strong and personalized manner, urge every tobacco user to quit. (Brief Strategy A2)
Assess willingness to try to quit. Is the tobacco user willing to quit now? (Brief Strategy A3)
Assist in quit attempt. For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him/her quit. (Brief Strategy A4)
Arrange follow-up.
Schedule follow-up contact, preferably within the first week after the quit date. (Brief Strategy A5)

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Helping Patients Stay Motivated to Quit

Relevance Encourage the patient to indicate why quitting is personally relevant, being as specific as possible. Motivational information has the greatest impact if it is relevant to a patient’s health status or risk.
Risks

Ask the patient to identify potential negative consequences of tobacco use.

  • Acute risks (e.g., shortness of breath, harm to pregnancy)
  • Long-term risks (e.g., heart attacks and strokes, cancers)
  • Environmental risks (e.g., increased risk of heart, lung and cancer disease among family members)
Rewards

Ask the patient to identify potential benefits of stopping tobacco use. Highlight benefits that are most relevant to the patient, such as:

  • Save money
  • Improve health
  • Food will taste better
  • Set a good example for children
  • Have healthier babies and children
Roadblocks

Ask patients to identify their barriers and concerns about quitting.

Common barriers and concerns may include:

  • Weight gain
  • Withdrawal symptoms
  • Lack of support
  • Enjoyment of tobacco
Repetition Repeat the motivational intervention every time an unmotivated patient visits the clinic. Remind patient that successful quitting often requires several attempts.

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Supporting Patients Who Have Recently Quit: Preventing Relapse

The following interventions should be part of every visit with a patient who has recently quit:

  • Congratulate the patient on any success and strongly encourage her/him to remain abstinent.
  • Use open-ended questions to encourage the patient to problem-solve challenges.

 

Encourage the patient to talk about:

  • Congratulate the patient on any success and strongly encourage her/him to remain abstinent.
  • Use open-ended questions to encourage the patient to problem-solve challenges.
  • Problems or anticipated threats to remaining abstinent

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CareOregon Benefits

 

Pharmacotherapy

Pharmacotherapy is fully covered by CareOregon. CareOregon requires a physician’s prescription for all pharmacotherapy options. Nicotine replacement therapy (NRT) is limited to gum and the patch. Bupropion SR (Zyban) and Chantix are covered. Chantix requires a written prescription and the member is encouraged to be enrolled in the Quit For Life® Tobacco Cessation Program.

Approved therapies are in the CareOregon Formulary on our web site. Ask Oregon Tobacco Quit Line staff about dosages and contraindications for these pharmaceuticals. The toll-free number is 1-800-QUIT-NOW (1-800-784-8669).

Pharmacotherapy during pregnancy

CareOregon supports the Clinical Practice Guideline developed by the U.S. Department of Health and Human Services Public Health Service (Treating Tobacco Use and Dependence, June 2008) about using nicotine replacement therapy and Bupropion during pregnancy. Search for “Bupropion” in the formulary.

Use the five A's brief interventions with a pregnant patient. Urge the patient to enroll in an intensive behavioral counseling service, such as the Quit For Life® Program.

Consider pharmacotherapy if a patient is a heavy tobacco user and is unable to quit with counseling only, and the potential benefits and likelihood of quitting outweigh potential risks.

Strong evidence supports proactive telephone counseling, group counseling and individual counseling in tobacco cessation. Nicotine replacement therapy is most effective when used with structured behavioral counseling.

Counseling

Tobacco cessation services are covered by CareOregon for both OHP and CareOregon Medicare Advantage members. No referral is required to provide tobacco cessation treatment and counseling. Providers are encouraged to follow the 5A’s model for treating tobacco use and dependence.

The free Oregon Tobacco Quit Line (1-800-Quit-NOW) is the first referral for providers without an in-house program. Providers may ask about recommended dosing levels and contraindications for NRT. The Quit For Life® Program is a covered benefit limited to once in a 12-month period. It offers telephone counseling and support.

If your patient wants to set a quit date, FAX a referral form to the Quit Line. A counselor will contact the patient. Registered callers may call the quit line for free cessation counseling as needed.

To contact the Oregon Tobacco Quit Line:

Fax: 1-800-483-3114

Call: 1-800-QUIT-NOW (784-8669) or TTY/TDD: 1-877-777-6534

Web sites: Oregon Tobacco Quit Line

Spanish-speaking counselors: 1-877- 2NO-FUME (266-3863)

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Patient information

 

Order patient information from the CareOregon Communications Department, 503-416-1741, or e-mail materials@careoregon.org. To order a free copy of CareOregon’s stop smoking packet to be mailed to your patient, call Customer Service at 1-800-224-4840. Please provide the member’s name and mailing address (one per household).

 

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Resources

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