Putting Science into Practice
In their article in the April 21 issue of the Journal of the National Cancer Institute, Dr. David A. Katz and his colleagues present the findings of the first randomized controlled trial to test the feasibility of implementing the smoking cessation guideline in primary care clinics and the effective behavioral counseling strategies in the guideline. The bottom line: It is feasible to use this guideline in primary care practice and its implementation leads to increased abstinence from smoking.
The Agency for Healthcare Research and Quality (AHRQ) is proud to have supported the development of the Smoking Cessation Clinical Practice Guideline in 1996 and, in 2000, to have been part of the consortium that developed its successor, the U.S. Public Health Service (PHS) Clinical Practice Guideline: Treating Tobacco Use and Dependence. However, we recognize that synthesizing the evidence is only the first step; we need to put this evidence into the hands of people who can use it immediately to change health and health care.
AHRQ's mission is "to improve the quality, safety, efficiency and effectiveness of health care for all Americans." We are working with public and private sector partners to translate the Guideline into improved health care practice. We also have developed a successful series of products and publications targeted to health care systems, clinicians, and consumers.
Our current partners include the American Cancer Society, Blue Cross and Blue Shield of California, the American Legacy Foundation, the Oregon State Health Division, and the Oklahoma Association of Optometric Physicians. As part of the National Partnership to Help Pregnant Smokers Quit, AHRQ has supported the implementation of the PHS guideline by prenatal care providers, resulting in quit rates of at least 30 percent among pregnant women.
AHRQ is building new partnerships with a variety of clinicians and organizations that directly influence care delivery. For example, AHRQ recently convened "Building Nursing Leadership in Tobacco Control," a historic meeting of 21 nursing organizations, representing almost a half million nurses. Nurses play a critical role in patient counseling and education, and we hope this will be the start of a broad-based effort by the nursing profession to support the implementation of cessation of tobacco use in clinical practice.
An essential component of strategies to promote smoking cessation is the identification of likely targets of opportunity. One AHRQ-supported study is evaluating rural emergency departments as an access point for teen smoking intervention, and another is studying smoking cessation interventions in maternal and child health clinics. Still other studies are examining physician profiling to increase smoking cessation, tailored outpatient nicotine replacement therapy, and evaluation of strategies to reduce smoking among Native American elders.
While effective smoking cessation efforts are, by definition, multipronged, primary care clinicians have important "teachable moments" with their patients. Moreover, patients who trust their primary care clinicians are far more likely to attempt lifestyle changes, including smoking cessation. Thus we are excited about our collaboration with the Robert Wood Johnson Foundation to help AHRQ-funded practice-based research networks (PBRNs) to develop creative, practical strategies for promoting healthy behaviors among patients that can be easily adopted by other primary care practices. The PBRN projects target the four health risk behaviors that represent the nation's leading causes of preventable disease, disability, health care burden, and premature death: tobacco use, sedentary lifestyle, unhealthy diet, and risky drinking.
Finally, in 2003, AHRQ's U.S. Preventive Services Task Force released a recommendation on counseling to prevent initial tobacco use that is consistent with the evidence in the PHS Clinical Practice Guideline. The Task Force's companion program, Put Prevention Into Practice, helps clinicians determine which services their patients should receive and makes it easier for patients to understand and keep track of their preventive care.
The PHS Clinical Practice Guideline on cessation of tobacco use provides evidence of what works, and with the Katz study we know that it can be implemented and lead to positive results. The imperative now is to identify effective incentives to sustain what works and spread successes across the nation to increase the number of Americans who successfully stop using tobacco. Please visit AHRQ's tobacco pathfinder Web site at www.ahrq.gov/path/tobacco.htm for a full menu of guideline tools.
Dr. Carolyn M. Clancy, Director, Agency