Cigarette smoking continues to lead to premature death with almost a half-million smokers dying each year in the U.S. Tobacco use causes numerous preventable diseases, including cancer as well as cardiovascular and pulmonary illnesses.
A recent Mayo Clinic Proceedings research study and editorial on "Helping Smokers Quit in the 'Real World,'" shows that smokers attempting to quit, using specialist clinics plus prescription medications, had more than 2.5 times the chance for successful abstinence versus unassisted quit attempts. And, using brief advice with prescription medications showed more than a 1.5 chance of successful abstinence compared with unassisted quitting.
The researchers also found that the use of over-the-counter (OTC) nicotine replacement therapies (NRT) without behaviorial support, consistently showed less chance of successful abstinence compared with unassisted quitting (0.68 chance).
The author suggests that "healthcare professionals should discourage patients from simply buying NRT off the shelf on their own," as this therapy may be even less effective than unaided quitting. Without behavioral support, NRT purchased over the counter results in worse outcomes compared with quitting unassisted. And this may stifle future quit attempts, reinforcing that "pharmacotherapy will not work for them."
The editorial quotes figures that only 4.8 percent of patients received the most effective therapy (specialist support with prescription medications) during their last quit attempt, while 20.8 percent of patients received brief advice with prescription medications. This suggests that approximately 75 percent of smokers are either using no prescription medications or support, or chosing NRT purchased on their own without any support — the most ineffective treatment.
What are the conclusions "Real World" author Dr. J.T. Hays makes for us? Practitioners should learn simple techniques to provide brief support, advise patients that medications will help them in their quit attempt and provide medications to those who are motivated to quit. When tobacco treatment specialists are available, practitioners should ask patients about their smoking status, advise them to quit and refer them for specialist treatment.
More than a dozen accredited programs are training tobacco treatment specialists (TTS) in the U.S. The groups have come together through an organization called the Association for the Treatment of Tobacco Use and Dependence (ATTUD), dedicated to evidence-based tobacco treatment for the tobacco user.
Within the next year, ATTUD hopes to offer a national credential for tobacco treatment specialists (CTTS), professionals who possess the skills, knowledge and training to provide effective, evidence-based interventions for tobacco dependence.
Currently, programs providing training for the TTS certification offer their own specific certificates, requiring attendance at a week-long workshop (some offering ACPE Pharmacy credit), proficiency on a final exam and approximately 250 hours of qualifying treatment time, with recertification within two years.
As you look at various programs, evaluate programs by their current accreditation with ATTUD. If they are not one of the dozen or so approved programs, your credentialing may be more difficult when national standards occur.
There is room for healthcare provider assistance to grow in the area of tobacco dependence treatment. Learn what you can do to positively impact the future for the 20 percent of Americans who currently smoke. Increasingly, pharmacists and other healthcare professionals can offer unique partnerships with patients to support and assist them in reaching important goals like quitting smoking. Consider becoming a TTS.
