Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
In Reply.—Dr Croghan and associates point
to the time constraints under which physicians practice. Their suggestion
that health care personnel other than physicians be considered to provide
smoking cessation services is consistent with AHCPR's guideline recommendations.
The guideline panel found that smoking cessation interventions delivered by
a variety of clinicians and health care personnel increase cessation rates
and, therefore, directed the clinical recommendations to primary care practitioners
(and smoking cessation specialists) rather than only to physicians. For the
purpose of our analysis, we assumed that physicians would conduct much of
the intervention that occurs in the office setting, such as advice and counseling.
We did this to generate a conservative estimate of the costs associated with
clinical services. But alternative staffing arrangements are quite plausible.
Use of clinicians other than physicians would reduce the cost of the intervention
or allow more intensive interventions at the same cost.
Cromwell J, Bartosch WJ, Fiore MC, Baker T, Hasselblad V. Cost-effectiveness of the AHCPR Guidelines for Smoking—Reply. JAMA. 1998;279(11):836-837. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-11-jac80001