Despite advances in modern medicine that enable organ transplants, hepatitis C cures, and the apply of artificial intelligence for radiology, one of the most crucial life-saving interventions—treatment for tobacco dependence—remains inconsistently delivered in clinical practice. Over 28 million Americans continue to smoke cigarettes, even though evidence-based treatments that are effective, affordable, and cost-efficient exist. Yet, across various health systems, physicians frequently fail to provide these treatments systematically.
Research shows that healthcare providers are not consistently offering evidence-based care to tobacco users. This inconsistency is reflected in data from the National Health Interview Survey, NCQA CAHPS surveys, medical claims studies, and electronic medical records. The barriers to effective tobacco treatment are well understood, and several effective solutions are available. The first step towards improvement is for healthcare providers to evaluate their own performance and commit to enhancing treatment delivery.
Enhancing Screening Practices
One of the first challenges in tobacco treatment is the underreporting of tobacco use in electronic medical records. Accurately identifying all forms of tobacco use is essential for effective intervention. Simply asking patients about their tobacco use can serve as an effective intervention itself. Failure to inquire about tobacco use can be seen as a tacit acceptance of the habit. Best practices for effective screening have been detailed by organizations like Kaiser Permanente of Northern California.
Providing Consistent Support and Treatment
Healthcare providers are encouraged to offer consistent advice to quit tobacco at every patient visit, regardless of the patient’s readiness to change. Clinical practice guidelines recommend that evidence-based treatments be available at each appointment. Trained clinical staff can document treatment under physician supervision, and billing for tobacco cessation counseling (CPT 99406) can be done for sessions lasting at least three minutes. This service can be billed up to eight times per year, even when patients are not currently trying to quit.
Medications and counseling, whether used alone or in combination, significantly enhance the chances of successful quitting. Varenicline, for instance, has been shown to be approximately 50% more effective than other cessation medications. Patients with insurance can access all cessation medications without copay or deductible, while varenicline is available for about $10 monthly for those without insurance through organizations like Cost Plus Drugs. Counseling services can be accessed free of charge via 1-800-QUIT-NOW (1-800-784-8669) or through various health plans.
The Importance of Follow-Up
Given that many individuals attempting to quit smoking relapse within the first week, scheduling follow-up visits or phone calls can significantly assist patients in staying on track. Such follow-ups can double the effectiveness of any intervention.
Clinicians often inquire about a patient’s “readiness to change,” which is part of the “stages of change” model. However, this approach can miss opportunities for treatment, as patients may still respond positively to motivational messages even if they do not consider themselves ready to quit. New research suggests the effectiveness of a “trial of quitting,” wherein patients can try cessation medications without having to set an immediate quit date. This method has shown success in helping patients maintain nicotine-free periods.
Addressing Mental Health Considerations
Many individuals use nicotine to self-medicate for underlying mood disorders. For example, those with serious mental illnesses tend to have higher rates of tobacco use and relapse. Since nicotine can act as an antidepressant, its cessation may lead to a resurgence of depressive symptoms. Patients who continue to face challenges in quitting may benefit from referrals to behavioral health specialists.
Most major medical centers have specialized clinics dedicated to tobacco treatment. These centers provide counseling from tobacco treatment specialists and coordinate medication use, optimizing the treatment experience.
Harm Reduction and Systems Change
For adults who struggle to quit smoking, harm-reduction strategies can be beneficial. FDA-authorized nicotine products, such as certain vaping devices or nicotine pouches, present a less harmful alternative to smoking combustible cigarettes.
Healthcare providers should adopt systematic changes to how tobacco treatment is delivered. A thorough assessment of current practices can reveal numerous opportunities to improve workflows, initiate and sustain treatment, and measure outcomes effectively.
As more patients are covered under value-based contracts, it’s crucial to evaluate the economic impact of tobacco treatment within clinical practices. This assessment can help quantify the financial benefits of smoking cessation initiatives.
significant improvements can be made in the delivery of tobacco treatment. With effective medications and proven counseling strategies available, the focus should shift from scientific challenges to organizational ones. Health systems must treat tobacco dependence with the same urgency as they do conditions like hypertension, diabetes, or heart disease. This includes consistently identifying patients who use tobacco, offering treatment at each visit, supporting quit attempts with medications and counseling, and systematically measuring performance. The data necessary for improvement is already present in electronic medical records; all it takes is a commitment to act.
If we aim for better health outcomes, it’s essential to prioritize tobacco cessation as a fundamental aspect of clinical care rather than treating it as an optional discussion point.
