Five Major Steps to Intervention (The "5 A's")
Successful intervention begins with identifying users and appropriate interventions based upon the patient's willingness to quit.
The five major steps to intervention are the "5 A's":- Ask
- Advise
- Assess
- Assist
- Arrange
- Ask: Identify and document tobacco use status for every patient at every visit. (You may wish to develop your own vital signs sticker, based on the sample below).
- Advise: In a clear, strong, and personalized manner, urge every tobacco user to quit.
- Assess: Is the tobacco user willing to make a quit attempt at this time?
- Assist: For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit. (See Counseling Patients to Quit and pharmacotherapy information in this packet).
- Arrange: Schedule follow-up contact, in person or by telephone, preferably within the first week after the quit date.
Treatment Process:
A chart of the treatment process.
- Ask: Do you currently use tobacco? If no, ask: Have you ever used tobacco? If no, arrange follow-up. If yes, assess: Have you recently quit? Any challenges?
- If the answer is "no," go to assist: encourage continued abstinence and arrange follow-up.
- If the answer is "yes," assist: provide relapse prevention and arrange follow-up.
- If the answer to the first question, Do you currently use tobacco? Is "yes," advise to quit.
- Then assess: Are you willing to quit now? If the answer is "no," assist: intervene to increase motivation to quit and arrange follow-up.
- If the answer to the question, Are you willing to quit now? Is "yes," assist: provide appropriate tobacco dependence treatment and arrange follow-up.
