Smoking cessation: health system challenges and opportunities

Area of Science:

• Public Health
• Clinical Medicine
• Health Services Research

Background:

• Despite recommendations from the Framework Convention on Tobacco Control, evidence-based tobacco treatment is not yet a standard of care.
• Clinical benefits of smoking cessation services in hospitals have been recognized for decades but implementation remains inconsistent.
• The Ottawa Model for Smoking Cessation offers a framework for organizational change to introduce cessation programs in healthcare settings.

Discussion:

• Clinicians have a fundamental responsibility to prioritize smoking cessation, as its public health significance exceeds many other preventive interventions.
• Implementing cessation services within cancer treatment protocols is crucial, though progress has been slow.
• Tailoring cessation service delivery to the specific realities and resources of diverse health systems, including low- and middle-income countries, is essential.

Key Insights:

• Smoking cessation services are a fundamental clinical responsibility, offering significant opportunities to assist patients.
• The Ottawa Model provides a successful approach to integrating cessation programs into hospital and primary care.
• Integrating cessation programs with services like tuberculosis control and standardizing peri-operative care can leverage existing resources.

Outlook:

• Mobile health technology presents unique opportunities for interactive cessation programming.
• Systemic health system changes are fundamental to improving the delivery of cessation services.
• Clinicians can act as powerful advocates for the necessary health system changes to enhance smoking cessation support.