"Advising patients to quit, even just once, helps to double quit rates. To initiate as many cessation attempts as possible, practitioners should advise all of their patients who smoke to quit," Dr. Bernard Le Foll and Dr. Tony George. T from CAMH, said.
Research has revealed that since an estimated 70 percent of smokers visit a physician each year, family doctors have a substantial opportunity to influence smoking behaviour. "Even a short intervention (three minutes or less) can increase a person's motivation to quit and can significantly increase abstinence rates," the researchers said.
They provide an algorithm topped by the simple question "Are you smoking"" to help physicians integrate a patient's smoking status and his or her readiness to quit, taking a comprehensive approach that combines assessment, behavioural interventions and pharmacologic treatment of tobacco dependence.
During the research, smokers with moderate to severe tobacco dependence have been found to respond best to three types of pharmacotherapy -- nicotine replacement therapy, bupropion and varenicline - but there is no clear threshold that can help clinicians decide whether a particular patient will benefit from a particular pharmacotherapy, and there is no consensus on which one should be used first.
The researchers provide physicians with a clear comparative table of these three first-line pharmacologic treatments, as well as advice on whether to combine these pharmotherapies, or to consider nortriptyline and clonidine as second-line medications.
Epidemiologic studies have indicated that the majority of successful attempts to quit smoking occur without direct medical assistance or without pharmacotherapy. "The use of nonpharmacologic methods (such as counseling) should be encouraged, especially for people for whom medication use is problematic. The goal is to motivate the patient to try to quit smoking," the researchers said.
Moreover, pharmacological interventions are clearly effective and allow doctors to double or triple the odds of success. The research is published in the November issue of the Canadian Medical Association Journal (CMAJ).