THE AGENCY FOR HEALTH-CARE POLICY AND RESEARCH SMOKING CESSATION CLINICAL-PRACTICE GUIDELINE

Objective.-To summarize the Smoking Cessation Clinical Practice Guidel ine that provides recommendations for 3 groups of professionals: prima ry care clinicians, smoking cessation specialists, and health care adm inistrators, insurers, and purchasers. Participants.-An independent pa nel of scientists, clinicians, consumers, and methodologists selected by the US Agency for Health Care Policy and Research. Evidence.-Englis h-language, peer-reviewed literature published between 1975 and 1994 t hat addresses the assessment and treatment of tobacco dependence, nico tine addiction, and clinical practice. Consensus Process.-Four panel m eetings were held over 2 years to evaluate meta-analytic and other res ults, to synthesize the results, and to develop recommendations. The G uideline was repeatedly reviewed and revised. Conclusions.-The panel r ecommendations address 3 audiences, Major recommendations for primary care clinicians are to use officewide systems to identify smokers, tre at every smoker with a cessation or motivational intervention, offer n icotine replacement except in special circumstances, and schedule foll ow-up contact to occur after cessation, Major recommendations to smoki ng cessation specialists are to use multiple individual or group couns eling sessions lasting at least 20 minutes each with sessions spanning multiple weeks, offer nicotine replacement, and provide problem-solvi ng and social support counseling, Major recommendations for health car e administrators, insurers, and purchasers are that tobacco-user ident ification systems be used in all clinics and that smoking cessation tr eatment be supported through staff education and training, dedicated s taff, changes in hospital policies, and the provision of reimbursement for tobacco-dependence treatment.