Michael C Fiore

I shall briefly summarise the process involved in preparing the Smoking cessation and prevention clinical practice guideline, sponsored by the US Agency for Health Care Policy and Research (AHCPR), including its rationale, process, intended audiences, implications, and schedule.

Effective clinical treatment of tobacco addiction is a necessary component of our overall national tobacco policy. While frequently stated, clinicians as well as health care managers and administrators have been reluctant participants in achieving this key goal. John Pinney summarised some of those data yesterday when he said that 70 % of smokers see a clinician every year, but up to half of them report they have never been asked and advised by their clinician to quit. In a survey of health care delivery systems and HMOs, only 65 % offered any coverage in their basic benefits package for smoking cessation and prevention. In contrast, virtually 100% of them offered coverage for the outcomes of smoking, whether they be pulmonary disease, acute myocardial infarction, or cancer.

Both clinicians and health care administrators frequently cite two reasons for their lack of participation : first, they say that there are no known and effective treatments for smoking cessation; and secondly, there is no consensus on what is effective treatment. The rationale for the smoking cessation guideline, therefore, is to produce a consensus statement based on current knowledge, with specific recommendations on how to implement the guidelines.

The process includes a panel of about 25 individuals - experts in smoking cessation, clinical practitioners, and consumers. While sponsored by AHCPR, this is a non-government panel. We have been charged with systematically reviewing all of the data on smoking cessation - more than 3000 articles. Virtually every article that has been published on clinical smoking cessation since 1975 has been reviewed.

We have done meta-analyses and …