Private practice with Dr Seth BilazarianView all posts »
Smoking cessation efforts in your practice: Has Chantix helped chip away at the smoking population?Mar 2, 2009 15:00 EST
In my cardiology practice approximately a third of patients seen to have a real willingness and desire to quit and are making active efforts to reduce their smoking with an aim towards cessation. Another third seemed content to "keep it under control" with responses such as I don't really inhale and I've cut way down from what I used to smoke. And the final third seen to enjoy smoking so much that they have no interest in discussing strategies for cessation and justify its ongoing use with responses such as "It’s the only pleasure I have" or "I don't have any other risk factors" or "I don't have any other vices"
In my practice strategies of nicotine replacement therapy have been only marginally successful and a handful of patients have replaced smoking addiction with nicotine addiction unable to give up nicotine gum after several years.
Chantix has been very useful strategy as a mono therapy; the success rate with my patient's has been similar to what has been reported in the clinical trials for this drug with about half of patient's succeeding at smoking cessation at 6 months. In my experience the best success seems to be with heavier smoker's - those smokers with greater than one pack per day cigarette smoking are the most able to reduce and ultimately quit
The warnings related to Chantix issues with depression have raised concerns amongst patients. The heightened press reports caused many patient s to resist Chantix as an aid to smoking cessation and a small number of patients have struggled heartburn and GI upset issues.
I have not experienced any issues with reimbursement by pharmacy benefits managers after the first several months after Chantix was first introduced. I am however unable to find any resources for nonpharmacologic therapies such as behavioral modification or counseling for smoking cessation and would welcome suggestions other physicians might have that they have access to further own patient's.
Our actual reimbursement from payers for smoking counseling using codes 99406 and 99407 ranges $10.06 to $50.01 depending on the payer as an add on to the office visit.
What challenges doother clinicans face with regard to use of pharmacologic therapies for smoking cessation? Do clinicans have success in referring patient for nonpharmacologic therapies and have success with hypnosis or other nonpharmacologic strategies? Any success using dual therapy either nicotine gum or patch ,Chantix or bupropion? Have insurers in your area reimbursed the smoking counseling codes?
Other resourcesNo Smoking Please on 60 minutes