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Initial therapy selection First-line pharmacotherapies for smoking cessation include nicotine replacement therapy (NRT), varenicline, and bupropion (table 1) 1,2,7-9. These treatments aim to reduce symptoms of nicotine withdrawal, thereby making it easier to stop using cigarettes.
When counseling your patients about smoking, the Agency for Healthcare Research recommends a brief smoking cessation intervention known as the "5 A's": Ask, Advise, Assess, Assist, and Arrange.ASSIST.Capitalize on teachable moments to discuss healthy lifestyle choices.
Set Your Quit Date. The first step to becoming smokefree is to choose when you want to quit.
The clinician can motivate patients to consider a quit attempt with the "5 R's": Relevance, Risks, Rewards, Roadblocks, and Repetition. Relevance - Encourage the patient to indicate why quitting is personally relevant.
Smoking Cessation Counseling Codes 99406 and 99407Medicare covers 2 cessation attempts per 12-month period. Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.
The options include:Prescription nicotine in a nasal spray or inhaler.Over-the-counter nicotine patches, gum and lozenges.Prescription non-nicotine stop-smoking medications such as bupropion (Zyban) and varenicline (Chantix)
The Ottawa Model for Smoking Cessation in 120 hospitals across Canada identifies the smoking status of all admitted patients, followed by brief advice, personalised bedside counselling, timely nicotine replacement therapy and/or pharmacotherapy, and follow-up after discharge 27.
5 Stages to QuittingPre-contemplation (not thinking about quitting)Contemplation (thinking about quitting but not ready to quit)Preparation (getting ready to quit)Action (quitting)Maintenance (remaining a non-smoker)16-Feb-2009
Successful intervention begins with identifying users and appropriate interventions based upon the patient's willingness to quit. The five major steps to intervention are the "5 A's": Ask, Advise, Assess, Assist, and Arrange. Ask - Identify and document tobacco use status for every patient at every visit.
The US Preventive Services Task Force (USPSTF) recommends using the 5 As model; ask, advise, assess, assist and arrange.