Tobacco Cessation Counseling
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| Performance Measure: Tobacco Cessation Counseling - OPR-Related Measure: No |
Percentage of clients [ 1 ] with HIV infection who received tobacco cessation counseling within the measurement year
Number of HIV-infected clients who received tobacco cessation counseling
Number of HIV-infected clients who:
- used tobacco products within the measurement year; and
- had a medical visit with a provider with prescribing privileges [ 2 ] at least once in the measurement period
Patients who deny tobacco use throughout the measurement year
- Is the client HIV-infected? (Y/N)
- If yes, did the client use tobacco during the reporting period? (Y/N)
- If yes, did the client receive tobacco cessation counseling during the measurement year?
- Electronic Medical Record/Electronic Health Record
- CAREWare, Lab Tracker or other electronic data base
- HIVQUAL reports on this measure for grantee under review
- Medical record data abstraction by grantee of a sample of records
- Billing records
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| National Goals, Targets, or Benchmarks for Comparison |
National HIVQUAL Data [ 3 ]
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2003 |
2004 |
2005 |
2006 |
2007 |
| Top 10% |
100.0% |
100.0% |
100.0% |
100.0% |
100.0% |
| Top 25% |
93.3% |
97.8% |
98.4% |
100.0% |
100.0% |
| Mean* |
69.3% |
75.0% |
76.8% |
81.8% |
83.8% |
*from HAB data base
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| Outcome Measures for Consideration |
- Rate of head & neck and lung cancer
- Rate of tobacco use in the clinic population
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| Basis for Selection and Placement in Group 3 |
A recent study has shown that lung cancer rates are 2.7 times greater for people living with HIV. [ 4 ] As tobacco use among HIV-infected patients poses significant health risks, tobacco-dependent patients should be provided assistance to enroll in smoking cessation programs. Various studies have shown that brief interventions by the clinician to encourage tobacco cessation and offer substitution programs can decrease smoking rates [ 5 ] and tobacco use. [ 6 ] Cessation reduces the risk of incidence or the progression of tobacco-related diseases and increases life expectancy. [ 7 , 8 , 9 ] HIV care providers should provide cessation assistance in the form of counseling, pharmacotherapy or referral to cessation programs.
The measure was placed in Group 3 because the feasibility of data collection can vary considerably across grantees.
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| US Public Health Service Guidelines |
"The U.S. Preventive Services Task Force strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products." [ 10 ]
[1] "Clients" includes all clients aged 13 years or older.
[2] A "provider with prescribing privileges" is a health care professional who is certified in their jurisdiction to prescribe medications.
[3] Tobacco Use (http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf)
[4] Philips, Abs 8, CROI, Boston , 2008.
[5] Page AR, Walters DJ, Schlegel RP, Best JA. Smoking cessation in family practice: The effects of advice and nicotine chewing gum prescription. Addict Behav 1986;11(4):443-6.
[6] Demers RY, Neale AV, Adams R, Trembath C, Herman SC. The impact of physicians' brief smoking cessation counseling: A MIRNET study. J Fam Pract 1990;31(6):625-9.
[7] Rigotti NA. Treatment of tobacco use and dependence. N Engl J Med 2002;346:506-51.
[8] Lancaster T, Stead L, Silagy C, Sowden A. Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. BMJ 2000;321:355-8.
[9] Methods, Successes, and Failures of Smoking Cessation Programs E B Fisher Jr,, E Lichtenstein, D Haire-Joshu, G D Morgan, H R Rehberg Annual Review of Medicine, February 1993, Vol. 44, Pages 481-513.
[10] Agency for Healthcare Research and Quality. The Guide to Clinical Preventive Services: Recommendations of the U.S. Preventive Services Task Force, June 2006, p. 120.
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