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Thursday, November 3, 2011

The Role of Hospitals in Helping Patients Quit

Partnership for Prevention’s ActionToQuit initiative is pleased to offer the “Helping Patients Quit” guide to hospital leaders and care providers as a useful tool in implementing a comprehensive tobacco cessation program. Screening all patients for tobacco use and offering treatment and follow-up to those who use tobacco is both good policy and practice.  Hospitals are a good place to intervene because the hospitalized tobacco user is, at least temporarily, is in a tobacco-free environment. Patients may be highly motivated to quit because tobacco use may have caused or contributed to their hospitalization. Unfortunately, hospitals have been slow to adopt programs to help their patients quit using tobacco.

The commentary Integrating Comprehensive Tobacco Treatment Into the Evolving US Health Care System highlights the significant impact of tobacco use treatment in a health care setting. A 1990 randomized control study of a hospital-based cessation program showed that cessation rates increased from 32% to 61% at one year follow-up among patients that had been hospitalized for heart attack. Despite these significant findings, little change occurred in the health care setting to address tobacco use.  In the past decade, however, progress has been noticeable, although still lagging considering the substantial evidence supporting the cost-effectiveness of tobacco use treatment.  In fact, the National Commission on Prevention Priorities (NCPP) found that tobacco screening and counseling is one of the few clinical preventive services that is cost-saving.

Current reforms and policies hint at a continued movement towards the integration of a comprehensive care management system for tobacco dependence in the health care system. Nevertheless, we must not be content with the current pace of progress, but rather double our efforts to save lives and reduce the suffering caused by tobacco use.

The Joint Commission has provided national leadership by developing new tobacco cessation performance measures and, as a result, many hospitals will make this a priority. It is Partnership’s hope that hospital leaders and practitioners will use the Helping Patients Quit guide to develop a tobacco cessation screening and treatment program for their facility and assist all patients who use tobacco to successfully quit.  

Sandhia Rajan
ActionToQuit Program Manager

Posted by: Alyson Hazen Kristensen at 12:00 AM
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Labels: cessation, healthcare, hospitals, tobacco

Tuesday, October 18, 2011

FDA's Achievements in Tobacco Control

In 2009, the Center for Tobacco Products was established within the FDA, allowing the agency to regulate tobacco products. In just two years, five historic regulations have ensured that consumers are fully aware of the dangers of tobacco and discouraged the onset of addiction. 

The five historic regulations are:

• Ban flavored cigarettes – in September 2009, the FDA banned flavored cigarettes, helping to limit youth initiation. Research had shown that tobacco companies were marketing cigarettes in various flavors to youth.
• Restrict youth access to tobacco products – in March 2010, the FDA issued a rule restricting access and marketing of cigarettes and smokeless tobacco products to youth. As a result, fewer retailers are selling tobacco products to youth across the country and enforcement of laws prohibiting sales  of tobacco products is stronger
• Ban misleading advertising claims – in June 2010, the FDA banned the use of claims like “low”, “medium”, and “light” on tobacco packaging to communicate that these products are not actually safer.
• Establish new smokeless tobacco health warnings – also in June 2010, the FDA established new smokeless tobacco warnings to advertise health risks.
• Issue new cigarette health warnings – in June 2011, the FDA released new graphic health warning labels for pack of cigarettes.

The FDA’s issuing of new graphic health warnings was the most significant change to cigarette warnings in 25 years. In addition to text, the new labels include large graphic images highlighting the health consequences of smoking. The national quit line number 1-800-QUIT-NOW is also on every pack.  The warning labels are estimated to reduce the number of smokers by 213,000 in 2013.

Partnership applauds the work of the Center of Tobacco Products and its achievements in the past two years to regulate Americans’ use of these legal, but undeniably harmful, products.

Jenna Frkovich
Tobacco Control Team

Posted by: Alyson Hazen Kristensen at 12:00 AM
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Labels: cigarettewarninglabels, FDA, regulate, tobacco

Friday, October 14, 2011

Not All Screening Tests Help Patients

“First, do no harm.” Most of us know that this phrase is the first tenet of medicine.  Unfortunately, health providers can inadvertently harm patients while trying to help them.  We know that certain tests, procedures, and even advice can unintentionally hurt a patient. We also know, from much research, that more health care doesn’t equal better health. 

The draft prostate cancer screening recommendation recently released by the US Preventive Services Task Force (USPSTF) brings this issue to the surface.  The USPSTF has recommended that healthy men should not be screened for prostate cancer using the prostate-specific antigen (PSA) screening test.  Although relatively inexpensive and painless, the USPSTF’s research found that testing for high PSA levels does not save lives.  In fact, many men suffered significant and lasting negative effects (including impotence) from the required follow-up procedures needed to determine if cancer is present.   The research also uncovered that men that are diagnosed with prostate cancer usually die from something else because their prostate cancer grew very slowly. Thus, the USPSTF has issued a D recommendation for routine PSA testing in healthy men, meaning that the harms of the test outweigh the benefits.  It still encourages shared decision-making between providers and their patients, and emphasizes that this recommendation does not apply to men with symptoms that are highly suspicious for prostate cancer.

Preventing disease is necessary for improving our nation’s health. But not all preventive services are effective.  Not all health care, even screening, is beneficial.  We must examine the evidence, carefully evaluate the harms versus the benefits, and follow wherever the evidence leads us, even if it means deviating from the norm.  As the chair of the USPSTF said, “…evidence — rather than tradition — should drive screening decisions.” Partnership couldn’t agree more.

Jason Spangler, MD, MPH
Chief Medical Officer

Posted by: Alyson Hazen Kristensen at 12:00 AM
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Labels: preventiveservices, prostatecancer, screening

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