| How
Can The 5A's Be Used? |
| The
5 A's were developed by the U.S. Public Health Service.
They represent a set of clinical practice guidelines for
Treating Tobacco Use and Dependence in patients. Activities
listed may be divided or shared among the clinic staff.
For example a receptionist may provide the patient with
an intake form that asks if the patient uses tobacco,
a physician may advise the patient to quit and prescribe
pharmacotherapy, a nurse may help the patient create a
quit plan, and a case manager may refer the patient to
intensive counseling and provide the follow-up.
|
| Note:
The 5A's is also available in a pdf format
|
| Specific
Components of the 5 A's
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|
| Ask |
|
Identify
and ensure documentation of tobacco use status (current,
former, never) for every patient on his or her initial
clinic visit.
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|
Update
the tobacco use-status of all adolescents at least annually
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|
Update
the tobacco-use status of all adult tobacco-users at least
annually.
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|
Update
the tobacco-use status of all adult, former tobacco-users
who have used tobacco in the last 5 years at least annually.
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| Advise |
|
In
a clear, strong, and personalized manner advise every
smoker to quit.
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| Assess |
|
Ask
each tobacco-using patient, "Are you ready to try
to quit using tobacco?"
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|
Provide
a motivational intervention to all patients unwilling
to quit: Discuss the Relevance of quitting
to the patient, Risks of tobacco use,
Rewards of quitting and solutions to
Roadblocks. Repeat at each visit.
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|
Review
past quit attempts to assess cessation strategies which
do and do not work for the patient.
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Diagnose
and treat underlying affective disorders, including anxiety
and depressive disorders, that inhibit success of cessation
treatments.
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| Assist |
|
Help
the patient make plans to:
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| |
| 1. |
Tell
family and friends about their decision to quit
and request support |
| 2. |
Anticipate
and plan for challenges to quit attempt, including
nicotine withdrawal symptoms, particularly in first
few weeks. |
| 3. |
Remove
tobacco from home, work & car. |
| 4. |
Avoid
alcohol.
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|
|
Recommend
FDA-approved pharmacotherapies to patients that desire
to quit as indicated
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|
Offer
FDA-approved pharmacotherapies to hospitalized patients
who use tobacco as indicated.
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Refer
the patient to the Utah Tobacco Quit Line (1-888-567-TRUTH),
Utah QuitNet (http://utahquitnet.com)
or to another group or individual cessation counseling
service providing 90-300 minutes of counseling divided
into at least 4 sessions.
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|
Distribute
tobacco cessation resources such as self-help manuals
and Quit Line referral cards.
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| Arrange
Follow-Up |
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Schedule
follow-up, either in person or on the phone
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Provide
relapse prevention intervention for all former tobacco
users, including congratulations for quitting, strong
encouragement to remain abstinent and a brief discussion
of the benefits derived from quitting and how to solve
any problems encountered or anticipated threats to continued
abstinence.
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|
Provide
prescriptive relapse prevention interventions to patients
that indicate problems with maintaining abstinence.
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