Department of Veterans Affairs
Veterans Health Administration
Office of Quality & Performance

TITLE: MANAGEMENT OF TOBACCO USE – UPDATE04

Citation:

Management of Tobacco Use. Washington, DC: VA/DoD Clinical Practice Guideline Working Group, Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense, December 1999 (Update 2004).  Office of Quality and Performance publication 10Q-CPG/TUC-04.

Completion Date:

June 2003

Release Date:

November 2004

Source(s):

The Tobacco Use Guideline was developed by and written for clinicians by the Department of Veterans Affairs (VA), Department of Defense (DoD)

Adaptation:

The guideline draws heavily from the 1999 VHA/DoD Clinical Practice Guideline to Promote Tobacco Use Cessation in the Primary Care Setting (v1.0;  The Clinical Practice Guideline for Treating Tobacco Use and Dependence. U.S. Department of Health and Human Services - Public Health Service (PHS); June 2000; and the Recommendations Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke. Task Force on Community Preventive Services; 2001.

Guideline Status:

This is the current release of the guideline update -2004.  An update is targeted for 2006.

Developer(s):

Veterans Health Administration (VHA), Department of Veterans Affairs (VA) - Federal Government Agency [U.S.]
Department of Defense (DoD) - Federal Government Agency [U.S.]

Funding Source:

United States Government

Committee:

The Management of Tobacco Use Working Group
 

Group Composition:

The list of contributors to this guideline includes nurses, therapists, psychologists, educators and smoking cessation specialist, internal medicine and primary care physicians, and experts in the field of guideline and algorithm development.

Disease/Condition:

Tobacco Dependence

Category:

Screening; Treatment; Early Recognition and Treatment of Co-morbid Conditions, Management; Evaluation

Intended Users:

While designed for use by primary care providers in an ambulatory care setting, the guideline can also be used to coordinate and standardize care within subspecialty teams and as teaching tools for students and house staff,

Target Population:

Any person who is eligible for care in the VA or DoD health care delivery system.

Contact Person(s):

VA:
Scott Sherman, MD, MPH
Smoking Cessation Coordinator
VA Greater Los Angeles Healthcare System
16111 Plummer Street
Sepulveda, CA 91343
Phone: 818-891-7711, ext.9909
Fax: 818-894-5838
E-mail: scott.Sherman@med.va.gov

DoD:
Col Gerald Talcott, PhD
Chief, Community Prevention Division
AFMOA/SGZF
2664 Flight Nurse, B801
Brooks, AFB 78235
Phone: 210-536-6771
Fax: 210-536-9032
E-mail: Wayne.Talcott@brooks.af.mil

GOALS/OBJECTIVES

The ultimate goal of the guideline is to assist patients to quit using tobacco and therefore, improve clinical outcomes.  The guideline specifically:

• Describes critical decision points in managing tobacco use cessation.
• Identifies tobacco users at high risk of adverse outcomes associated with continued tobacco use.
• Assists primary medical care providers and specialists with the early detection of symptoms, assessment of treatment readiness, determination of the appropriate setting and intensity of treatment and delivery of individualized interventions.
• Reinforces the need for patient education regarding abstinence from tobacco and prevention of future relapses.

INTERVENTIONS AND PRACTICES

The guideline is addressing distinct aspects of the following:

Triage

Assessment

Behavioral treatment options

Pharmacotherapy

Further evaluation and treatment

Primary prevention and prevention of relapse

OUTCOMES CONSIDERED

Reduced tobacco or nicotine use.

MAJOR RECOMMENDATIONS

The Tobacco Use Cessation (TUC) guideline is presented in an algorithmic format with annotations.  It focuses on screening to determine current tobacco use, determining readiness to quit, identifying appropriate interventions, assessing risk for starting tobacco use, and assessing risk for relapse.

CLINICAL ALGORITHM ARE PROVIDED FOR:

Page one of the algorithm is addressing Screening, Assessment, Behavioral treatment and  Pharmacotherapy. Second algorithm addresses prevention and relapse prevention in individual not using tobacco.

For an interactive algorithm with links to the annotations return to the TUC-home page and select the link to the "Complete Guideline"

TYPE OF EVIDENCE

The guideline is supported by the literature in a majority of areas with evidence-based tables and references throughout the document.  The evidence consists of key clinical randomized controlled trials and longitudinal studies in the areas of tobacco use cessation.  Where existing literature is ambiguous or conflicting, or where scientific data are lacking on an issue, recommendations are based on the expert panel's opinion and clinical experience.  The guideline contains an annotated bibliography and discussion of the evidence supporting each recommendation.

DESCRIPTION OF METHODS TO COLLECT EVIDENCE

The algorithm and annotations were based on an exhaustive review of the literature.  The goal of the literature review was to provide a systematic basis for the development of an evidence-based guideline.  The inclusion criteria for the literature search were related to the population being studied (adult) and the treatment setting (primary care).

 The Medical Subject Headings (MeSH) terms used for the search included key therapies in hypertension, study characteristics, and study design.  In this search, study characteristics were those of analytic studies, case-control studies, retrospective studies, cohort studies, longitudinal studies, follow-up studies, prospective studies, cross-sectional studies, clinical protocols, controlled clinical trials, RCTs, intervention studies, and sampling studies.   Study design included crossover studies, double-blind studies, matched pair analysis, meta-analysis, random allocation, reproducibility of results, and sample size.

See Tobacco Use Guideline  Introduction.

METHODS TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

The Grading Scheme Used for the Guideline

REVIEW METHODS

Peer Review

ENDORSERS

VHA 's National Clinical Practice Guideline Council
DoD/VA Clinical Practice Guidelines Working Group

QUALIFYING STATEMENTS

Clinical practice guidelines, which are increasingly being used in health care, are seen by many as a potential solution to inefficiency and inappropriate variations in care. Guidelines should be evidenced-based as well as based upon explicit criteria to ensure consensus regarding their internal validity. However, it must be remembered that the use of guidelines must always be in the context of a health care provider's clinical judgment in the care of a particular patient. For that reason, the guidelines may be viewed as an educational tool analogous to textbooks and journals, but in a more user-friendly tone.

GUIDELINE AVAILABILITY

Electronic copies available from:
The Office of Quality and Performance web site.

Copy Statement: No copyright restrictions apply