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March 18, 1998

Cost-effectiveness of the AHCPR Guidelines for Smoking—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(11):836-837. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-11-jac80001

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.