Essential elements of an effective practice based tobacco cessation system
| 1. Identification of all tobacco users |
| • Nursing staff ask all patients with unknown status about their tobacco use during rooming (children with much secondhand smoke exposure are considered to be smokers too) |
| • Charts are labelled to identify current use, recent (past year) use, and non-use |
| • At subsequent visits, those labelled as current and recent users are asked about use |
| 2. Physician reminders |
| • Information about current use and past interest and plans about quitting |
| • Prominent flags about this information, eg, using a coloured smoke card (fig 1) |
| 3. Physician message |
| • Assess interest in quitting (preferably using readiness-to-change stages)36 |
| • Advise of the importance of quitting |
| • Negotiate quit date if in preparation stage |
| • Offer assistance and follow up as appropriate for readiness stage |
| • Reinforce value of actions by others |
| 4. Assistance |
| • Stage matched educational materials |
| • Counselling resources, preferably on site or phone based |
| • Medication if appears to be needed or desired |
| 5. Follow up |
| • At all office visits, based on 1 and 2 above |
| • Phone call soon after quit date to assess progress and reinforce action |