CHEST Guidelines-Rebuttal-From-Dr-Hitsman-et-al_2017

Rebuttal-From-Dr-Hitsman-et-al_2017_chest

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In a debate on effective strategies for smoking cessation, Dr. Hitsman and colleagues argue that specialized treatments delivered by advanced practice professionals (APPs), such as behavioral health specialists, are crucial for optimizing smoking cessation outcomes. They acknowledge the importance of patient motivation and treatment timing but emphasize that specialized behavioral and pharmacologic treatments are necessary to mitigate the personal and economic burden of smoking-related diseases. They propose that while all medical team members can support smoking cessation, APPs are uniquely positioned to deliver intensive treatments, particularly in specialized respiratory clinics. There is consensus on the need for integrated tobacco and respiratory care but a call for more research is made to evaluate effective methods in respiratory settings.<br /><br />Dr. Perez and colleagues counter this argument, agreeing on the importance of addressing smoking cessation across all disciplines but questioning the assumption that APPs achieve better outcomes than physicians. They reference meta-analyses showing similar cessation rates between physicians and nonphysicians, suggesting brief counseling by physicians combined with pharmacotherapy is effective and potentially more cost-effective than intensive counseling. Both groups acknowledge COPD patients as crucial targets for intervention, with Perez advocating for continuous patient education regardless of disease progression. The dialogue underscores a need for further study to refine integrated care models and verify the superior effectiveness of APPs versus physicians in smoking cessation efforts.

Keywords

smoking cessation

advanced practice professionals

behavioral health specialists

pharmacologic treatments

respiratory clinics

integrated care

COPD patients

patient education

meta-analyses

cost-effectiveness