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The Centers for Disease Control and Prevention (CDC) says that more deaths are caused each year by tobacco use than from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined. Research confirms that secondhand smoke causes disease and premature death in children and adults who do not smoke.
CareOregon encourages providers to use multiple strategies to reduce tobacco use by our members:
Brief Clinical Strategies For
Patients Willing To Quit (Five A’s)
Ask about tobacco use. |
Identify and document tobacco use status for every patient at every visit. (Brief Strategy A1)
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Advise to quit. |
In a clear, strong and personalized manner, urge every tobacco user to quit. (Brief Strategy A2)
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Assess willingness to try to quit.
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Is the tobacco user willing to quit now?
(Brief Strategy A3)
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| Assist in quit attempt. |
For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him/her quit. (Brief Strategy A4)
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| Arrange followup. |
Schedule followup contact, preferably within the first week after the quit date. (Brief Strategy A5) |
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Helping patients stay motivated to quit
| Relevance |
Encourage the patient to indicate why quitting is personally relevant, being as specific as possible. Motivational information has the greatest impact if it is relevant to a patient’s health status or risk. |
| Risks |
Ask the patient to identify potential negative consequences of tobacco use.
- Acute risks (e.g., shortness of breath, harm to pregnancy)
- Long-term risks (e.g., heart attacks and strokes, cancers)
- Environmental risks (e.g., increased risk of heart, lung and cancer disease among family members)
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| Rewards |
Ask the patient to identify potential benefits of stopping tobacco use. Highlight benefits that are most relevant to the patient, such as:
- Save money
- Improved health
- Food will taste better
- Set a good example for children
- Have healthier babies and children
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| Roadblocks |
Ask patients to identify their barriers and concerns about quitting.
Common barriers and concerns may include:
- Weight gain
- Withdrawal symptoms
- Lack of support
- Enjoyment of tobacco
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| Repetition |
Repeat the motivational intervention every time an unmotivated patient visits the clinic. Remind patient that successful quitting often requires several attempts. |
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Supporting Patients Who Have Recently Quit: Preventing Relapse
The following interventions should be part of every visit with a patient who has recently quit:
- Congratulate the patient on any success and strongly encourage her/him to remain abstinent.
- Use open-ended questions to encourage the patient to problem-solve challenges.
Encourage the patient to talk about:
- Benefits she/he has gained by not using tobacco
- Success she/he has had in quitting
- Problems or anticipated threats to remaining abstinent
CareOregon Benefits
Pharmacotherapy
Pharmacotherapy is fully covered by CareOregon. CareOregon requires a physician’s prescription for all pharmacotherapy options. Nicotine replacement therapy (NRT) is limited to gum and the patch. Bupropion SR (Zyban) and Chantix are covered. Chantix requires a written prescription and the member must be enrolled in the Free & Clear Tobacco Cessation Program.
Approved therapies are in the CareOregon Formulary on our web site. For more information:
- In the Providers section of this web site, select the Pharmacy page.
- Scroll down. Select Formulary Search.
- For plan type, click either Medicare/CareOregon Advantage or Oregon Health Plan.
- For drug class, click “smoking cessation” in the drop-down menu.
- Click Search.
Ask Oregon Tobacco Quit Line staff about dosages and contraindications for these pharmaceuticals. Their toll-free number is 1-800-QUIT-NOW (1-800-784-8669).
Pharmacotherapy during pregnancy
CareOregon supports the Clinical Practice Guideline developed by the U.S. Department of Health and Human Services Public Health Service (Treating Tobacco Use and Dependence, June 2000) about using nicotine replacement therapy and Bupropion during pregnancy. Search for “Bupropion” in the document.
Use the five A’s brief interventions with pregnant patient. Urge the patient to enroll in an intensive behavioral counseling service, such as Free & Clear.
Consider pharmacotherapy if a patient is a heavy tobacco user and is unable to quit with counseling only, and the potential benefits and likelihood of quitting outweigh potential risks.
Strong evidence supports proactive telephone counseling, group counseling and individual counseling in tobacco cessation. Nicotine replacement therapy is most effective when used with structured behavioral counseling.
Counseling
- Brief counseling or a referral to a tobacco cessation program. Plan benefit limit is two (2) referrals per 12-month period (CPT S9075, ICD-9 305.1).
- In-house counseling is covered for ten (10) sessions per 12-month period
(CPT G9016, ICD-9 305.1).
The free Oregon Tobacco Quit Line (1-800-Quit-NOW) is the first referral for providers without an in-house program. Providers may ask about recommended dosing levels and contraindications for NRT. Free & Clear is a covered benefit limited to once in a 12-month period. It offers telephone counseling and support.
If your patient wants to set a quit date, FAX a referral form to the Quit Line. A counselor will contact the patient. Registered callers may call the quit line for free cessation counseling as needed.
To contact the Oregon Tobacco Quit Line and Free & Clear Program:
Patient information
Order patient information from the CareOregon Communications Department, 503-416-1741, or e-mail materials@careoregon.org:
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