Are there any specific suggestions for working with patients who smoke?

Smoking is more complicated because there is no healthy, acceptable level of smoking. Nevertheless, physicians should still meet patients where they are. When I talk to my patients about quitting, we try to choose a time that is least anxiety-provoking, with the understanding that there will never be a completely stress-free time in life, but some periods have fewer stressors than others. I tell patients that they need a support system, not only for smoking but for all other changes as well.

What type of support systems do you recommend?

Behavioral change and improving public health is an all-in proposition. Beyond a patient’s individual support system of family or friends, there are community-based organization that can develop programs and support systems to help people make changes. In Atlanta, where I live, some community-based organizations are starting a walking club. We also have local jurisdictions that are making it easier to increase physical activity by implementing walkable places, such as safe sidewalks, or special lanes for bicycling. When we talk about behavior change, we want to make sure that the broader community is also involved.

What role can physicians play in community involvement with these issues?

Physicians who are interested in this type of involvement have a unique opportunity to help patients on an individual and a community level. They might become part of community coalitions. Or they might find an innovative way to motivate patients. I have known of some physicians who are involved with a program called “Walk with a Doc”,3,4 in which patients and physicians meet and walk together on a regular basis.

How can busy physicians make time for these conversations?

It is certainly a challenge. Team-based care can come into play here, where other staff members, such as nurses, medical assistants, and nurse educators can be in the office and offer smoking cessation programs, education regarding pre-diabetes, or how to increase physical activity.

Reimbursement will be available in the future for services related to wellness visits. This will increase opportunities for physicians to support these wellness changes. Recently, billing codes are being developed for obesity counseling and other issues, and preventive care is being funded.

Here at the AMA, we have been working with the Centers for Disease Control and Prevention (CDC) on diabetes prevention.5 Through Prevent Diabetes STAT,5 a national partnership launched with the Centers for Disease Control and Prevention in 2015, the AMA has succeeded in screening for prediabetes and referring patients to evidence-based diabetes prevention programs, which have been shown to greatly improve patient outcomes. The program partners with the YMCA in offering classes. This is another example of community partnership and teamwork. And because of the work of the AMA, CDC, and American Diabetes Association (ADA), Medicare will reimburse providers for offering this diabetes prevention program, starting in 2018.

Is there any role for technology in motivating patients and helping them stay on track with their goals?

I know that many physicians would like to integrate more technology into their practices. The AMA is also very interested in technological innovations. So it is clear that, going forward, technology will increasingly play a role as we work with our patients. Currently, some clinics and physicians use texts not only for appointment reminders but also for asking patients if they remembered to take their medications. However, we are early on in the process of integrating technology into medical practice. We want to make sure that we study and have the evidence base regarding what does and does not work. Technology has a great deal of potential, but we want to be sure that it improves patient outcomes and care delivery without being excessively burdensome to physicians, which can contribute to burnout.

References:

1.      7 Health Recommendations for New Year’s Resolutions. Available at: https://www.ama-assn.org/7-health-recommendations-new-years-resolutions. Accessed: January 19, 2017.

2.      Norcross JC, Vangarelli DJ. The resolution solution: longitudinal examination of New Year’s change attempts. J Subst Abuse. 1988-1989;1(2):127-34.

3.      Walk with a Doc. Available at: http://walkwithadoc.org. Accessed: January 19, 2017.

4.      Abbasi J. As Walking Movement Grows, Neighborhood Walkability Gains Attention. JAMA. 2016;316(4):382-383.

5.      Prevent Diabetes STAT. Available at: https://assets.ama-assn.org/sub/prevent-diabetes-stat/. Accessed: January 19, 2017.