A clinical practice guideline for treating tobacco use and dependence - A US Public Health Service report

Objective To summarize the recently published US Public Health Service repo rt Treating Tobacco Use and Dependence. A Clinical Practice Guideline, whic h provides recommendations for brief clinical interventions, intensive clin ical interventions, and system changes to promote the treatment of tobacco dependence. Participants An independent panel of 18 scientists, clinicians, consumers, and methodologists selected by the US Agency for Healthcare Research and Qu ality. A consortium of 7 governmental and nonprofit organizations sponsored the update. Evidence Approximately 6000 English-language, peer-reviewed articles and ab stracts, published between 1975 and 1999, were reviewed for data that addre ssed assessment and treatment of tobacco dependence. This literature served as the basis for more than 50 meta-analyses. Consensus Process One panel meeting and numerous conference calls and staff meetings were held to evaluate meta-analytic and other results, to synthes ize the results, and to develop recommendations. The updated guideline was then externally reviewed by more than 70 experts and revised. Conclusions This evidence-based, updated guideline provides specific recomm endations regarding brief and intensive tobacco cessation interventions as well as system-level changes designed to promote the assessment and treatme nt of tobacco use. Brief clinical approaches for patients willing and unwil ling to quit are described. Major conclusions and recommendations include: (1) Tobacco dependence is a chronic condition that warrants repeated treatm ent until long-term or permanent abstinence is achieved. (2) Effective trea tments for tobacco dependence exist and all tobacco users should be offered those treatments. (3) Clinicians and health care delivery systems must ins titutionalize the consistent identification, documentation, and treatment o f every tobacco user at every visit. (4) Brief tobacco dependence treatment is effective, and every tobacco user should be offered at least brief trea tment. (5) There is a strong dose-response relationship between the intensi ty of tobacco dependence counseling and its effectiveness. (6) Three types of counseling were found to be especially effective-practical counseling, s ocial support as part of treatment, and social support arranged outside of treatment. (7) Five first-line pharmacotherapies for tobacco dependence-sus tained-release bupropion hydrochloride, nicotine gum, nicotine inhaler, nic otine nasal spray, and nicotine patch-are effective, and at least 1 of thes e medications should be prescribed in the absence of contraindications. (8) Tobacco dependence treatments are cost-effective relative to other medical and disease prevention interventions; as such, all health insurance plans should include as a reimbursed benefit the counseling and pharmacotherapeut ic treatments identified as effective in the updated guideline.