Copyright © 1998 by Institute for Clinical Systems Integration
The information contained in this web site, including the ICSI Health Care
Guidelines ("ICSI Guidelines"), is intended primarily for health
professionals and the following expert audiences:
Neither the ICSI Guidelines nor any other information in this web site should be construed as medical advice or medical opinion related to any specific facts or circumstances. If you are not one of the expert audiences listed above you are urged to consult a health care professional regarding your own situation and any specific medical questions you may have. In addition, you should seek assistance from a health care professional in interpreting the materials in this web site and applying the materials in your individual case.
The ICSI Guidelines contained in this web site are designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients, and are not intended either to replace a clinician's judgment or to establish a protocol for all patients with a particular condition. An ICSI Guideline rarely will establish the only approach to a problem.
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Work Group Leader
Leif I. Solberg, MD, HealthPartners
Cardiology
Thomas E. Kottke, MD, Mayo Clinic
Family Practice
Donald A. Pine, MD, HealthSystem Minnesota
Michael Schoenleber, MD, HealthPartners
Health Education
Jane A. Norstrom, Institute for Research & Education
Internal Medicine
David Klevan, MD, HealthPartners
Leif I. Solberg, MD, HealthPartners
Nursing
Joanne Kellan, RN, HealthPartners
Ob/Gyn Nurse Practitioner
Renee Compo, RN, CNP, HealthPartners
Pediatrics
Susan Asch, MD, Stillwater Medical Group
Measurement Advisor
Leif I. Solberg, MD, HealthPartners
BHCAG Representative
Sandra Dahl, Honeywell, Inc.
Facilitator
Chris Schroeder, RN, ICSI
Children and adolescents.
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Priority Aims for Medical Groups
When Using This Guideline
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Clinical Algorithms & Annotations
Algorithm Annotations:
1. Community Intervention
The work group urges ICSI member medical groups, HealthPartners, and employers to actively intervene within their community to reduce tobacco use. Participation in school-based education, limiting youth access to tobacco, restrictions on advertising, counteradvertising and increasing economic disincentives to tobacco use are among the effective actions that deserve active support.
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2. Establish Smoke Exposure at Nearly Every Visit
Smoke exposure (in home, at day care, etc.) should be established at
nearly every visit.
If there is anyone smoking around the child, regard the infant or child
as a passive smoker.
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Documentation should be made of every tobacco-use discussion, either in the progress notes or in a separate flow-sheet or card.
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5. If Someone In The Child's Home Smokes
The adult accompanying the child should be advised about the dangers to the child of passive tobacco exposure. Educational and self-help material should be provided. If the user is present, s/he should be encouraged to quit. If the user is a clinic patient and is interested in quitting, s/he should follow-up with his/her primary care provider. (Refer to the Tobacco Prevention and Cessation for Adults and Mature Adolescents guideline.)
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6. Establish Patient's Use of Tobacco at Appropriate Visits
The patient's use of tobacco should be established at nearly every visit, as the teen years are the main age at which tobacco use begins and use may occur at any time.
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9. Patients Not Interested in Quitting
A user not ready to consider quitting is called a precontemplator and is helped most when a provider avoids confrontation while conveying both the message that quitting is important and and desire to be helpful when the user is ready to consider quitting. The short-term negative effects of tobacco, such as bad breath, yellowed fingers, and smelly clothes, should be emphasized. The benefits of quitting should also be stressed. These include fewer respiratory illnesses, better performance in sports, and the money saved by not buying tobacco. It can also be noted that it is easier to stop using tobacco in youth than later in adulthood. Educational material should be provided.
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10. Patients Interested in Quitting
The contemplator is interested in quitting in the next 1-6 months.
Contemplators are accepting of support and respectful urging to quit and
encouragement to start thinking about a serious plan to do so. Persuasive
written, audio or video information about the pros and cons of quitting
may be appropriate for contemplators.
Users in the preparation stage are ready to attempt to quit in the
next month. It is always appropriate to request the user to set a quit
date within the next 1-3 weeks, to provide self-help information or suggestions,
and (most importantly) to encourage the user to accept some form of follow-up
soon after the quit date. Follow-up can occur by mail or telephone.
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13. If Parent, Sibling or Friend Uses Tobacco
All patients who wish to stop using tobacco or who do not currently
use tobacco should be asked if their parents, siblings or friends use tobacco.
If someone does smoke around the patient, the patient should be assisted
in developing refusal skills and given educational materials.
If the person who uses tobacco is present, she or he should be encouraged
to quit. If the user is a clinic patient and is interested in quitting,
he or she should be given encouragement, materials and resources at this
visit, and referred for follow-up by his or her primary care provider.
(Refer to the Tobacco Prevention and Cessation for Adults
and Mature Adolescents guideline.)
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Grade A: Conclusion based on a randomized, controlled trial that
has been published
in a peer-reviewed
journal.
Grade B: Conclusion based on one of the following study types published
in a
peer-reviewed
journal (but not on a randomized, controlled trial):
Grade C: Conclusion based on one of the following (but not on
any studies of the
types mentioned
above):
Guidelines obtained from the Agency for Health Care Policy and Research (AHCPR) or other sources, position statements, panel consensus statements from the National Institutes of Health (NIH) or elsewhere, review articles, and textbook chapters that cite primary evidence are not assigned a grade because they are not primary evidence. The individual studies cited in such secondary sources can be graded according to the categories presented above.
Other Guideline Referenced Within This Guideline
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