277 lines
No EOL
16 KiB
HTML
277 lines
No EOL
16 KiB
HTML
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
|
|
"http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml">
|
|
<head>
|
|
<title>Research Activities, April 1996: Clinical Practice Guidelines</title>
|
|
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
|
|
|
|
<!-- "metadata" -->
|
|
<meta name="Title" content="Research Activities, April 1996" />
|
|
<meta name="keywords" content="Agency for Health Care Policy and Research, Agency for Healthcare Research and Quality, AHRQ, AHCPR, AIDS/HIV, ambulatory care, benchmark, child, cost, elderly, health cost, healthcare cost, hospital, long-term care, managed care, markets, mental health, methodology, minority health, nursing, nursing homes, outcome research, out-of-pocket spending, patient care, primary, primary care, research, rural, spending, study, Translating Research Into Practice, TRIP" />
|
|
<meta name="description" content="Online newsletter summarizing published findings from AHRQ-funded studies, new AHRQ publications and products, and funding opportunities." />
|
|
<meta name="creator" content="Agency for Healthcare Research and Quality (AHRQ)" />
|
|
<meta name="datecreated" content="April 1996" />
|
|
<meta name="datereviewed" content="April 1996" />
|
|
<meta name="language" content="English" />
|
|
<!-- end metadata -->
|
|
<link href="/includes/archive.css" rel="stylesheet" type="text/css" />
|
|
<link href="/includes/ahrqstyleprint_arch.css" rel="stylesheet" type="text/css" media="print" />
|
|
<script>
|
|
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
|
|
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
|
|
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
|
|
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
|
|
|
|
ga('create', 'UA-75759936-1', 'auto');
|
|
ga(' set', 'anonymizeIp', true);
|
|
|
|
ga('send', 'pageview');
|
|
|
|
</script></head><body><!-- Google Tag Manager -->
|
|
<noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-W4DST4"
|
|
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
|
|
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
|
|
new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
|
|
j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src=
|
|
'//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
|
|
})(window,document,'script','dataLayer','GTM-W4DST4');</script>
|
|
<!-- End Google Tag Manager -->
|
|
<noscript>
|
|
Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
|
|
</noscript>
|
|
|
|
<!-- Page Header v2.0 -->
|
|
<a name="top" id="top"></a>
|
|
<!--Begin Banner CodeS-->
|
|
<div id="ahrqbanner">
|
|
<div class="hhsportion">
|
|
<a href="#h1" class="skipnav">Skip Navigation</a>
|
|
<a href="http://www.hhs.gov" title="U.S. Department of Health and Human Services">
|
|
<img src="/images/hhs_banner.gif" alt="U.S. Department of Health and Human Services" />
|
|
</a>
|
|
<a href="http://www.hhs.gov" title="www.hhs.gov" class="hhsright">
|
|
<img src="/images/hhs_link.gif" alt="www.hhs.gov" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ahrqportion">
|
|
<a href="/" title="Archive: Agency for Healthcare Research Quality">
|
|
<img src="/images/ahrq_banner.gif" alt="Agency for Healthcare Research Quality" />
|
|
</a><form name="searchForm" method="get" action="https://search.ahrq.gov/search" id="banner_searchform">
|
|
<label for="search" style="z-index:-1;position:relative;margin-right:-65px; font-size:0px;">Search</label>
|
|
<input name="q" type="text" value=" Search Archive" size="11" onfocus="this.value='';" class="gotext" label="Search archive" id="search" />
|
|
<input type="hidden" name="entqr" value="0" />
|
|
<input type="hidden" name="output" value="xml_no_dtd" />
|
|
<input type="hidden" name="proxystylesheet" value="ARCHIVE_Front_End" />
|
|
<input type="hidden" name="client" value="ARCHIVE_Front_End" />
|
|
<input type="hidden" name="site" value="ARCHIVE_AHRQ_GOV" />
|
|
<input src="/images/topbn_GoButton.gif" class="gobtn" name="Submit" onclick="javascript:document.searchForm.submit();" type="image" alt="Search" />
|
|
</form>
|
|
<a href="https://www.ahrq.gov/" class="ahrqright">www.ahrq.gov</a>
|
|
</div><div class="ahrqlinks"><a href="https://www.ahrq.gov/">AHRQ Home—Live Site</a> | <a href="/">Archive Home</a> | <a href="/sitemap.htm">Site Map</a> <!-- | <img src="/images/envelope1.jpg" alt="" width="21" height="14" /><a href="https://subscriptions.ahrq.gov/service/multi_subscribe.html?code=USAHRQ">E-mail Updates</a> --></div>
|
|
</div>
|
|
<div id="PrintBanner">
|
|
<img src="/images/printbanner_arch.jpg" alt="Archive print banner" />
|
|
</div>
|
|
<a name="h1"></a>
|
|
<!-- End banner code -->
|
|
<!-- End of Page header -->
|
|
|
|
<!-- Content Body -->
|
|
<div id="mainContent">
|
|
<table width="100%" border="0" cellspacing="0" cellpadding="0" >
|
|
<tr valign="top">
|
|
<td width="70%">
|
|
<!-- Center Content section -->
|
|
<table width="100%" border="0" cellpadding="0" cellspacing="0" style="margin-left:10px; margin-right:10px;margin-top:5px" summary="This table gives the layout format of the bread crumb area and the center content area.">
|
|
<!--DWLayoutTable-->
|
|
<tr>
|
|
<td class="crumb_link"><div id="crumbContent">
|
|
<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> > <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> > <a href="." class="crumb_link">April 1996</a> </span></p>
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td><h1><a name="h1" id="h1"></a>Clinical Practice Guidelines </h1>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td><div id="centerContent"><div class="headnote">
|
|
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
|
|
|
|
|
|
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
|
|
|
|
<a name="head1"></a>
|
|
<h2>New guideline challenges clinicians to help smokers quit</h2>
|
|
<p>Clinicians should aggressively help their smoking patients quit,
|
|
according to a new clinical practice guideline sponsored by the
|
|
Agency for Health Care Policy and Research. The guideline,
|
|
developed by a panel of smoking cessation experts, challenges all
|
|
clinicians, including doctors, nurses, dentists, and others, to
|
|
find out if their patients smoke, repeatedly encourage them to
|
|
quit, and recommend treatments proven to work.</p><p>
|
|
|
|
The 19-member panel was led by Michael C. Fiore, M.D., M.P.H.,
|
|
Director of the University of Wisconsin's Center for Tobacco
|
|
Research and Intervention, and included physicians, nurses,
|
|
mental health experts, a dentist, a pharmacist, psychologists, an
|
|
epidemiologist, an educator, and a consumer representative.</p>
|
|
|
|
<p>The panel's recommendations include using the nicotine patch or
|
|
nicotine gum—which doubles the chances of successfully
|
|
quitting—combined with a clinician's encouragement and
|
|
support and practical advice to smokers on how to cope with
|
|
situations and behaviors that make them want to smoke.</p><p>
|
|
|
|
According to Douglas B. Kamerow, M.D., M.P.H., AHCPR's director
|
|
of clinical practice guideline development, there are about 46
|
|
million adult smokers in the United States, and more than 70
|
|
percent of them would like to stop smoking. Dr. Kamerow calls on
|
|
clinicians to approach smoking as a chronic condition that is
|
|
very difficult but not impossible to treat.</p>
|
|
|
|
<p>This is the first time the total body of information on smoking
|
|
cessation has been analyzed systematically. In developing the
|
|
guideline, the panel reviewed over 3,000 scientific articles that
|
|
addressed the assessment and treatment of tobacco dependence,
|
|
nicotine addiction, and clinical practice.</p><p>
|
|
|
|
Only half the smokers who see a doctor have ever been urged to
|
|
quit. If only 100,000 physicians helped 10 percent of their
|
|
patients end their addiction each year, the number of smokers in
|
|
the United States would drop by an additional 2 million people
|
|
annually.</p>
|
|
|
|
<p>Smoking is the single greatest preventable cause of illness and
|
|
death in the United States. People who smoke are at increased
|
|
risk of heart disease, cancer, and other smoking-related
|
|
illnesses that contribute to over 420,000 deaths a year. Medical
|
|
costs for smokers are $50 billion annually, with an additional
|
|
$47 billion for indirect expenses, such as time lost from work
|
|
and disability.</p><p>
|
|
|
|
The AHCPR-supported guideline recommends that clinicians:</p>
|
|
<ul>
|
|
<li>Ask every patient at every visit if he or she smokes.</li>
|
|
<li>Write a patient's smoking status in the medical chart under
|
|
vital signs.</li>
|
|
<li>Ask patients about their desire to quit, and reinforce their
|
|
intentions.</li>
|
|
<li>Motivate patients who are reluctant to quit.</li>
|
|
<li>Help motivated smokers set a quit date.</li>
|
|
<li>Prescribe nicotine replacement therapy. (<strong>Editor's Note:</strong> The
|
|
FDA has approved nicotine gum for over-the-counter use; the
|
|
nicotine patch may be approved for OTC use by the end of
|
|
1996.)</li>
|
|
<li>Help patients resolve problems that result from quitting.
|
|
Counseling may be helpful to some patients to increase the
|
|
likelihood of success.</li>
|
|
<li>Encourage relapsed smokers to try quitting again.</li>
|
|
</ul>
|
|
<p>Other recommendations to health care administrators,
|
|
purchasers, and insurers include changing the health care
|
|
delivery systems to make it a standard practice to identify
|
|
and treat smokers and other tobacco users.</p><p>
|
|
|
|
The consumer brochure released along with the guideline urges
|
|
smokers to: </p>
|
|
<ul>
|
|
<li>Be committed. Be aware that breaking nicotine addiction
|
|
isn't easy and takes a significant individual effort, but
|
|
that half the people who have ever smoked have quit.</li>
|
|
<li>Talk with their doctors and discuss nicotine replacement
|
|
therapy and smoking cessation programs. Do everything
|
|
possible to maximize the chance of success.</li>
|
|
<li>Set a quit date; do not try to "taper off."</li>
|
|
<li>Build on past mistakes. Think about what helped and what
|
|
hurt.</li>
|
|
<li>Create a support network of family and friends to be
|
|
supportive and reinforce stop smoking efforts.</li>
|
|
<li>Learn how to cope with situations that make a person want to
|
|
resume smoking.</li>
|
|
<li>Focus less on weight gain. Most people who stop smoking will
|
|
gain less than 10 pounds, but the health benefits of quitting smoking
|
|
outweigh the risks of weight gain.</li>
|
|
<li>Avoid dieting while trying to give up smoking because it can
|
|
undermine chances of quitting.</li>
|
|
</ul>
|
|
<p>
|
|
Whenever possible, smoking cessation treatments should be
|
|
appropriately tailored to ethnic or racial groups. The guideline
|
|
also offers recommendations for pregnant women, hospitalized
|
|
patients, and persons with psychological problems.
|
|
Recommendations also address tobacco prevention and cessation in
|
|
children and adolescents and use of smokeless tobacco products
|
|
(snuff and chewing tobacco).</p>
|
|
|
|
<p>No conclusions were drawn about the effectiveness of acupuncture,
|
|
hypnosis, and drug therapies such as clonidine, antidepressants,
|
|
and anxiolytics/benzodiazepines because of insufficient or
|
|
inconclusive evidence.</p><p>
|
|
|
|
The panel also made no recommendations regarding the use of
|
|
nicotine nasal sprays and nicotine inhalers, since data on these
|
|
products were limited. At the time of the panel's deliberations,
|
|
the products were not licensed for prescription use in the United
|
|
States. (<strong>Editor's Note:</strong> As the guideline went to press, the
|
|
Food and Drug Administration approved the prescription use of
|
|
nicotine nasal spray.)</p>
|
|
|
|
<p>AHCPR plans to disseminate the guideline, cosponsored by the
|
|
Centers for Disease Control and Prevention, to a wide range of
|
|
clinicians, smoking cessation specialists, health care
|
|
administrators, purchasers, and insurers. A quick reference
|
|
guide, pocket guide, and consumer version, in English and
|
|
Spanish, also will be distributed.</p><p>
|
|
|
|
The American Medical Association has received an educational
|
|
grant from the Robert Wood Johnson Foundation to send copies of
|
|
the guideline to 200,000 primary care doctors. AHCPR also will
|
|
work with the American Association of Health Plans (formerly
|
|
GHAA/AMCRA) to develop a practical guide, based on the guideline
|
|
recommendations, targeted to meet the needs of health care
|
|
systems.</p>
|
|
|
|
<p>The guideline publications <em>Smoking Cessation: Quick Reference
|
|
Guide for Primary Care Clinicians</em> (AHCPR Publication No.
|
|
96-0693); <em>Smoking Cessation: Quick Reference Guide for Smoking
|
|
Cessation Specialists</em> (AHCPR Publication No. 96-0694); and
|
|
<em>You Can Quit Smoking: Guide for Consumers</em> (AHCPR
|
|
Publication No. 96-0695) are available from <a href="https://www.ahrq.gov/research/publications/order/order-research-activities.html">AHCPR</a>.</p>
|
|
|
|
<p class="size2"><a href=".">Return to Contents</a><br />
|
|
<a href="dept9.htm">Proceed to Next Article</a></p>
|
|
<div class="footnote">
|
|
<p> The information on this page is archived and provided for reference purposes only.</p></div>
|
|
<p> </p>
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
<!-- End of Center Content section -->
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
</div>
|
|
<!-- End of Content Body -->
|
|
<!-- Footer graphic 1.2-->
|
|
<table cellspacing="0" cellpadding="0" border="0" width="100%">
|
|
<tr>
|
|
<td width="125" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_1.jpg" width="125" alt="AHRQ" /></td>
|
|
<td width="100%" background="/images/bottom_ahrq_bkg.jpg" ><img src="/images/bottom_ahrq_bkg.jpg" width="10" height="34" alt="" /></td>
|
|
|
|
<td width="310" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_2.gif" alt="Advancing Excellence in Health Care" width="310" height="34" /></td>
|
|
</tr>
|
|
</table>
|
|
<!-- Footer links section -->
|
|
<div id="banner_Footer2"><p> <a href="https://www.ahrq.gov/">AHRQ Home</a> | <a href="https://info.ahrq.gov" class="footer_navlink">Questions?</a> | <a href="https://www.ahrq.gov/contact/index.html" class="footer_navlink">Contact AHRQ</a> | <a href="https://www.ahrq.gov/sitemap.html" class="footer_navlink">Site Map</a> | <a href="https://www.ahrq.gov/policy/electronic/accessibility/index.html" class="footer_navlink">Accessibility</a> | <a href="https://www.ahrq.gov/policy/electronic/privacy/index.html" class="footer_navlink">Privacy
|
|
Policy</a> | <a href="https://www.ahrq.gov/policy/foia/index.html" class="footer_navlink">Freedom of Information Act</a> | <a href="https://www.ahrq.gov/policy/electronic/disclaimers/index.html" class="footer_navlink">Disclaimers</a> | <a href="http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html" class="footer_navlink">Plain Writing Act</a> <br />
|
|
|
|
<a href="http://www.hhs.gov" class="footer_navlink">U.S. Department of Health & Human Services</a> | <a href="http://www.whitehouse.gov" class="footer_navlink">The White House</a> | <a href="http://www.usa.gov" class="footer_navlink">USA.gov: The U.S. Government's Official Web Portal</a></p>
|
|
</div>
|
|
<div id="banner_Footeraddress"><p>Agency for Healthcare Research and Quality <img src="/images/bottom_dot.gif" alt="" /> 5600 Fishers Lane Rockville, MD 20857 <img src="/images/bottom_dot.gif" alt="" /> Telephone: (301) 427-1364</p></div>
|
|
|
|
<!-- End of Footer links section -->
|
|
</body>
|
|
</html> |