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Smoking Cessation Update

Mike Weinstock, MD and Rob Crane, MD

No me gusta!

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Mike and Rob dive back in to give you some new finds on Smoking Cessation from the March 2016 Edition of Urgent Care RAP.

Baker TB, et al. Effects of Nicotine Patch vs Varenicline vs Combination Nicotine Replacement Therapy on Smoking Cessation at 26Weeks. A Randomized Clinical Trial. JAMA. 2016;315(4):371-379

Matt M., MD -

This was good stuff - as usual. I have an unrelated question - I have been tasked by our CEO here with developing a policy for the providers regarding recommendations for follow up visits in the UC clinic. Or in other words, what patient scenarios should always have a follow visit performed? The prototype, of course, would be the abscess I&D who should be seen in 48 hours for removal of the packing, and decision on repacking - I have been doing that for my 10 yrs in UC full time. But, I can't say I routinely recommend a follow up visit for anyone else - I tell everybody to come back (or go to the ER) if they are not improving at 48 hours, but don't consider it mandatory. So, for example, the asthmatic that comes in wheezing up a storm, hypoxic - gets better with treatments and a shot of Decadron - should they have a mandatory F/U visit. Or the dehydrated vomiting diabetic with gastroenteritis who does not appear to be in DKA with a BS of 280 - gets IV saline and zofran, eg. Is there any kind of "industry-wide" policy established for this that you know of? What is your opinion? Does it all just go back to case by case judgement?

Mizuho M., DO -

Hi Matt,
Great question. I do think we have to consider each case individually, however you pose an interesting question. I've actually reached out to an expert on this topic, and we hope to have a more industry specific answer for you regarding policies that are useful. So hang tight! ~mizuho

Mike W., MD -

Hi Matt and thx for the question. I do not know of any official protocols for this, but in my practice I ask people to return if I am concerned bout disease progression and they don't have reliable follow up. Regarding the packing removal, I used to do this but now u just have them pull it out themselves in 2 days. No complications so far!! I hope this is helpful... --Michael

Mike W., MD -

Could be a combination... Of course everyone who starts the medication is by definition 'motivated' to quit based on the fact that they are taking the med in the first place! And you are correct, this 2016 JAMA study did not have a control arm. Thx for the astute observation!!

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Smoking Cessation Update Full episode audio for MD edition 6:01 min - 3 MB - M4A