Quality of care can be defined as the level to which health services for patients and the community increases the possibility of desired health outcome. Following tobacco addiction, people develop other comorbidities and complications, which include cancer, cardiovascular diseases, and respiratory diseases, tobacco use can also increase the risk of depression and anxiety, vision and eye problems, and rheumatoid arthritis (Centers for Disease Control and Prevention, 2022) These conditions impact the care that tobacco addicts receive. This is because healthcare professionals must consider the comorbidities while planning for patient care. These conditions make it difficult the diagnosing and treatment of the condition.
Healthcare providers are required to make medical decisions while putting into consideration comorbid conditions. Comorbidities affect the quality of care a patient receives since some conditions might be unrelated in pathogenesis requiring separate, time-intensive treatment plans. In some situations, some conditions may go undetected; therefore, during a patient assessment, it is necessary to be more vigilant. Comorbidities can also lead to suboptimal management, missed diagnosis, and insufficient treatment. Additionally, when a patient has various chronic conditions, they might be cared for by various medical professionals increasing the possibility of conflicting information, unnecessary laboratory tests and inappropriate treatment medications. Patients with tobacco addiction are at a higher risk of receiving suboptimal care due to other comorbid conditions.
Additionally, tobacco addicts must manage daily symptoms that affect their quality of life. To manage these symptoms, tobacco addicts need to make frequent hospital visits, increasing healthcare costs. Patients who lack medical insurance tend to receive poor-quality care since they cannot afford the increased medical cost. They are also less likely to adhere to recommended medical regimens and counselling services, which are costly, affecting the quality of care they receive.
Patient Safety
Patient safety can be defined as the efforts of healthcare providers to avoid preventable harm, infections, or injuries during treatment. Safety among tobacco addicts refers to providing the best treatment to the patient while preventing the side effects of drugs and any complications resulting from the condition. Tobacco addicts are exposed to diseases such as pulmonary infections, COPD, myocardial infractions, rheumatoid arthritis, cancers, peptic ulcer disease, reproductive abnormalities, and cardiovascular diseases, which impact their safety. They also experience delayed wound healing, reduced effectiveness of cancer treatment, and altered drug clearance. Tobacco users are exposed to premature death caused by smoking complications or smoking-related fires in their residential buildings (Onor et al., 2017).
Most tobacco users suffer from other underlying conditions and must take more than one prescription medication to manage them. Polypharmacy may impact a patient’s safety since a drug may interact with a treatment for another problem or with another condition in the patient’s body. These interactions can cause bad reactions, which may cause harm to the patient.
To treat tobacco addiction, various smoking cessation treatments are recommended. They include nicotine replacement therapy in various forms, such as transdermal, buccal, oral, respiratory, and nasal administration, and non-nicotine medication like varenicline and bupropion. Like any other medication, these drugs have various side effects that may impact patient safety (Motooka et al., 2018). For instance, varenicline may cause nausea, abdominal pain, vomiting, headache, and insomnia. It may also lead to depression, anxiety, hallucination, and suicide. Varenicline also increases the risk of cardiovascular diseases. Bupropion, on the other hand, might lead to nausea, vomiting, insomnia and dizziness. Electronic cigarettes are famous nicotine replacement therapy that might lead to pneumonia, seizures, congestive heart disease, headache, nausea, cough, throat, and eye irritation (Motooka et al., 2018).
Costs
Tobacco addiction imposes enormous health and financial costs on the healthcare system and the individual patient. In the United States, one in every five people dies from a smoking-related illness, causing about 480,000 deaths yearly. Tobacco use causes chronic illnesses such as cardiovascular diseases, cancers, and respiratory illnesses, which causes death and disability among tobacco consumers. Smoking accounts for billions of dollars of yearly finances in the United States. In 2018, the US spent more than $240 billion on healthcare costs. These healthcare costs incurred included outpatient treatment, specialists care, and access to general practitioner visits. Additionally, informal carer costs are also incurred when the family members provide unpaid care to the chronically ill patient. Smokers and society incur costs in terms of payments for over-the-counter medication to treat smoking-related illnesses.
Tobacco addicts die prematurely from smoking-related illnesses and conditions, which accounts for about $185 billion in lost productivity. Tobacco-related illness increases absenteeism and reduces health-related performance in the workplace. Furthermore, lost productivity from smoking-related premature death accounts for approximately $180 billion and $7 billion in lost productivity caused by premature deaths resulting from secondhand smoke exposure (Centers for Disease Control and Prevention, 2022).
Policies
The Affordable Care Act expanded Medicaid services among United States residents with low income who were previously Medicaid-eligible. The policy also ensured that all insurers covered preventive services such as smoking cessation interventions with no cost sharing among newly eligible Medicaid beneficiaries. When out of pockets costs for cessation treatment were reduced, a higher rate of medication use was observed. This ensured that nicotine-dependent patients had access to evidence-based tobacco treatment compared to Medicaid pre-expansion. ACA led to increased primary care visits which enhanced access to smoking cessation medication which in turn helped patients in quitting (Bailey et al., 2022).
Another policy that impacts the quality of care, patient safety, and the cost is smoke-free public places legislation. The policy ensures that the public is protected from secondhand smoking effects. It has helped reduce the level of heart attack and pregnancy-related complications. It has also reduced childhood asthma hospitalization. The legislation is reported to reduce health risks associated with smoking among smokers (Anyanwu et al., 2018)
Recommended Strategies
The potential strategies and best practices for tobacco addiction include pharmacological interventions, behavioural therapy, support groups and counselling therapies. The FDA has approved a variety of medication that increases quitting success rates. Medications are responsible for easing withdrawal symptoms and ensuring that smokers adjust to new ways of thinking and behaving without using tobacco. Among the pharmacological interventions include nicotine replacement therapies, which include nicotine patches, nicotine gum, lozenges, inhalers, and nasal sprays. The medication helps stimulate the brain receptors targeted by nicotine which in turn helps relieve withdrawal symptoms and cravings that are the main cause of relapse. The medication is started on the date that the patient decides to quit. Studies have shown that nicotine replacement therapy increases the possibility of sustained quitting by about 50 to 60 %. Varenicline increases the possibility of stopping smoking in standard or reduced doses. Bupropion increases the possibility of quitting by 52 to 71% (Selby & Zawertailo, 2022).
Additionally, smokers should be provided with brief advice to quit. This involves encouraging the smoker to set a quit date after deciding to quit. Another effective intervention is offering individual or group counselling. This involves providing practical approaches to adjusting to challenges when one stops smoking, like withdrawal symptoms and treatment adherence. It may also involve cognitive behavioural therapy, an approach that helps the patient identify triggers and teaches them relaxation skills that helps prevent relapse. Evidence has shown that individual behavioural counselling greatly enhanced quitting compared to brief advice or self-help with no medication offered. Another effective approach is contingency management, which involves financial rewards to smokers who quit and maintain abstinence. The approach is highly effective; however, many smokers relapse when they no longer receive the rewards.
Moreover, text messaging is also effective in improving quit rates. Finally, motivational interviewing is commonly recommended. This technique enhances smokers’ motivation to make healthy changes (Selby & Zawertailo, 2022).
References
Anyanwu, P. E., Craig, P., Katikireddi, S. V., & Green, M. J. (2018). Impacts of smoke-free public places legislation on inequalities in youth smoking uptake: study protocol for a secondary analysis of UK survey data. BMJ open, 8(3), e022490. https://doi.org/10.1136/bmjopen-2018-022490
Bailey, S. R., Voss, R., Angier, H., Huguet, N., Marino, M., Valenzuela, S. H., Chung-Bridges, K., & DeVoe, J. E. (2022). Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: An observational cohort study. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-07860-3
Centers for Disease Control and Prevention. (2022, February 23). Economic trends in tobacco. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm
Centers for Disease Control and Prevention. (2022, July 21). Health effects of smoking and tobacco use. https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm
Motooka, Y., Matsui, T., Slaton, R. M., Umetsu, R., Fukuda, A., Naganuma, M., Hasegawa, S., Sasaoka, S., Hatahira, H., Iguchi, K., & Nakamura, M. (2018). Adverse events of smoking cessation treatments (nicotine replacement therapy and non-nicotine prescription medication) and electronic cigarettes in the Food and Drug Administration Adverse Event Reporting System, 2004-2016. SAGE open medicine, 6, 2050312118777953. https://doi.org/10.1177/2050312118777953
Onor, I. O., Stirling, D. L., Williams, S. R., Bediako, D., Borghol, A., Harris, M. B., Darensburg, T. B., Clay, S. D., Okpechi, S. C., & Sarpong, D. F. (2017). Clinical Effects of Cigarette Smoking: Epidemiologic Impact and Review of Pharmacotherapy Options. International journal of environmental research and public health, 14(10), 1147. https://doi.org/10.3390/ijerph14101147
Rigotti, N. A., Kruse, G. R., Livingstone-Banks, J., & Hartmann-Boyce, J. (2022). Treatment of Tobacco Smoking: A Review. JAMA, 327(6), 566–577. https://doi.org/10.1001/jama.2022.0395
Selby, P., & Zawertailo, L. (2022). Tobacco addiction. New England Journal of Medicine, 387(4), 345–354. https://doi.org/10.1056/nejmcp2032393
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