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

Rebuttal-From-Dr-Perez-et-al_2017_chest

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In a rebuttal article published in "Chest" journal in September 2017, Mario F. Perez, Lori A. Bastian, and Cheryl Oncken challenge Hitsman and colleagues’ assertion that advanced practice professionals (APPs) achieve better smoking cessation outcomes than physicians. The authors acknowledge the global health burden of smoking and agree that all healthcare providers, including physicians, nurses, social workers, and others, should address smoking cessation with patients. However, they disagree with the claim that APPs are more effective than physicians in this task.<br /><br />Perez et al. point to a meta-analysis of 29 studies that evaluated smoking abstinence rates resulting from counseling by physicians compared to other non-physician providers like psychologists and nurses. The findings showed that physicians achieved an abstinence rate of 19.9%, similar to the 15.8% rate for non-physicians, suggesting no significant advantage for APPs over physicians.<br /><br />The authors underscore the effectiveness of brief counseling by physicians, noting that longer counseling does not necessarily yield better results. They also highlight the cost-effectiveness of pharmacotherapy over intensive counseling, particularly in patients with chronic obstructive pulmonary disease (COPD). Therefore, they advocate for strategies that integrate brief counseling with pharmacological support.<br /><br />Acknowledging that smokers with COPD are a crucial target group for cessation interventions, Perez and colleagues emphasize the importance of continuous education and treatment efforts even after smoking-related diseases develop. They encourage healthcare providers to educate patients about the dangers of smoking and available cessation therapies.<br /><br />The authors conclude by stressing the collaborative role of healthcare professionals in addressing nicotine addiction, aiming to deliver personalized and effective patient care. They disclose existing financial support from the NIH for related research, with Pfizer Pharmaceuticals providing some study materials.

Keywords

smoking cessation

advanced practice professionals

physicians

meta-analysis

counseling effectiveness

pharmacotherapy

COPD

healthcare providers

nicotine addiction

personalized care