Rebuttal From Dr Hitsman et al

TY - JOUR

T1 - Rebuttal From Dr Hitsman et al

AU - Hitsman, Brian

AU - Baker, Amanda L.

AU - King, Andrea

N1 - Funding Information: Brian Hitsman PhD a ∗ b-hitsman@northwestern.edu Amanda L. Baker PhD b Andrea King PhD c a Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL b National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use School of Medicine and Public Health University of Newcastle Newcastle NSW Australia c Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL Department of Psychiatry and Behavioral Neuroscience University of Chicago Chicago IL ∗ CORRESPONDENCE TO: Brian Hitsman, PhD, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Dr, Ste 1400, Chicago, IL 60611 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine 680 North Lake Shore Dr, Ste 1400 Chicago IL 60611 As part of their counterpoint argument, Drs Perez, Bastian, and Oncken suggest that patient motivation to quit smoking and the timing of treatment are more important influences than the type of health-care provider who delivers smoking cessation treatment. 1 Although we agree that motivation and treatment timing are important factors in smoking cessation treatment, we maintain that specialized behavioral and pharmacologic treatments will be required to optimize smoking cessation outcomes and reverse the rising personal and economic burden of smoking and respiratory disease. Although all members of the medical team can contribute to delivery of the 5 As, 2 a recommendation made by Drs Perez, Bastian, and Oncken, advanced practice professionals (APPs), including behavioral health specialists (eg, psychologists, social workers) are uniquely qualified to provide the type and intensity of treatment needed to optimize smoking cessation outcomes for patients in the specialty respiratory clinic. Such patients are especially likely to be highly nicotine dependent and have other characteristics associated with smoking persistence (e.g., psychological comorbidities). We agree with Drs Perez, Bastian, and Oncken that it is not practical to train most physicians, especially those in specialty care settings, to deliver motivational interviewing to promote smoking cessation treatment engagement and attempts at smoking cessation. However, physicians can play an important role in supporting treatment that involves motivational interviewing and in delivering novel motivational treatments, such as precessation pharmacotherapy that emphasizes smoking reduction as an intermediate step to quitting. 3 Clearly, much more research is needed to determine which evidence-based treatments, techniques, and approaches are particularly effective for smokers with respiratory disease. In a network meta-analysis of six controlled trials involving smokers with COPD, 4 behavioral counseling plus nicotine replacement therapy was more effective in enhancing long-term abstinence when compared with usual care (eg, brief advice), counseling alone, or counseling plus antidepressant medication. A critical point of agreement between us and Drs Perez, Bastian, and Oncken is the need to integrate tobacco treatment and respiratory care. 5 Integrated care models incorporating specialist respiratory and primary care expertise are associated with improved outcomes, including fewer hospital admissions and better attendance for pulmonary rehabilitation. 6,7 These have focused on primary care interventions carried out by medical and nurse practitioner staff in the patient’s home or within the clinic setting. Such models could include behavioral health specialists to train and supervise primary health care staff and deliver clinical interventions to more complex patients. This needs to be a research priority as we are unaware of such an integrated care model in a respiratory care setting. If shown to be effective and cost-effective, system barriers including institutional support and provider reimbursement would need to be addressed to sustain integrated care for high tobacco burden smokers such as those with COPD. Nonetheless, all patients in the respiratory care setting who report tobacco use should receive empirically supported smoking cessation and relapse prevention treatment. Although an integrated multidisciplinary team model may be optimal, any provision of these services, regardless of the issue of delivery by an APP or physician, is important to prevent disease exacerbation and premature death.

PY - 2017/9

Y1 - 2017/9

UR - http://www.scopus.com/inward/record.url?scp=85028965862&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028965862&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2017.03.032

DO - 10.1016/j.chest.2017.03.032

M3 - Editorial

C2 - 28414031

AN - SCOPUS:85028965862

SN - 0012-3692

VL - 152

SP - 472

EP - 473

JO - Diseases of the chest

JF - Diseases of the chest

IS - 3

ER -