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Recommendations

Recommendations


UK National Institute for Health and Care Excellence (NICE) guidelines

Identify people who smoke- people should be asked if they smoke by their healthcare practitioner , and those who smoke should be offered advice on how to stop

  • People who smoke should be offered referral to an evidence-based smoking cessation service
  • People who smoke should be offered behavioural support with pharmacotherapy by an evidence based smoking cessation service
  • People who seek support to stop smoking and who agree to pharmacotherapy should be offered a full course
  • People who smoke and have set a quit date with an evidence-based smoking cessation service should be assessed for exhaled carbon monoxide levels 4 weeks after their quit date
  • Secondary healthcare settings should ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies are available on site for patients, visitors and employees
  • Smokers unwilling or not ready to stop smoking should be offered a harm reduction approach to smoking
  • Smokers unwilling or not ready to stop smoking should be advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine
  • Smokers unwilling or not ready to stop smoking should be advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products
  • 'Stop smoking' services should offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step

US Public Health Service guidelines – 2008 Update

  • Clinic screening systems such as expanding the vital signs to include tobacco use status, or the use of other reminder systems such as chart stickers or computer prompts, are essential for the consistent assessment, documentation and intervention with tobacco use.
  • All patients should be screened for tobacco use and assessed for their interest in quitting.
  • All physicians and clinicians should strongly advise every patient who smokes to quit.
  • All healthcare personnel and clinicians should repeatedly and consistently deliver smoking cessation interventions to their patients.
  • Patients should be encouraged to use varenicline, NRT or bupropion for smoking cessation with evidence suggesting that combination NRT or varenicline are particularly effective (see Safety section for more information about use in special populations).
  • To be most effective, interventions should include either individual, group or telephone counselling/contact.
  • Both counselling and cessation medications by themselves are effective. Combining counselling and cessation medications boosts cessation rates additionally.
  • Intensive interventions are more effective than brief interventions and should be used when resources permit, but every smoker should be offered at least a minimal or brief intervention.
  • Smoking cessation interventions should help smokers recognize and cope with problems encountered in quitting (problem solving/skills training), should provide social support as part of treatment, and should encourage smokers to seek support from family and friends.
  • Where feasible, smokers attempting to quit with self-help material alone should be provided with access to support through a telephone hotline/helpline.

US Preventive Services Task Force (USPSTF) recommendations:

Clinicians should ask all adults about tobacco use

, advise them to stop using tobacco

, and provide behavioural interventions and U.S. Food and Drug Administration (FDA)–approved pharmacotherapy for cessation to adults who use tobacco

clinicians should ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioural interventions for cessation to pregnant women who use tobacco

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