Tobacco and health care [response]
Online posting: May 23, 1997
Published in print: July 15, 1997 (CMAJ 1997;157:133)
Re: "Tobacco and health" [CMA policy summary]. Can Med
Assoc J 1997;156:240A-C [full text / texte complet].
In response to: W.W. Arkinstall; R. Finlayson
Both of Dr. Arkinstall's concerns have been addressed to an
extent in the policy. The CMA is well aware of the issue of
reimbursement for smoking-cessation counselling and other
preventive services. An article in the same issue of CMAJ
in which the policy appears includes a table of billing codes
that could be used for clinical tobacco intervention (CTI) in
each province and territory. CMA recognizes the need for
reimbursement models to recognize the preventive health services
provided by physicians. CMA's tobacco policy recommends that CTI
be recognized as an essential part of health care and as a core
medical service (i.e., one covered by provincial and territorial
health insurance plans). The policy also deplores the domestic
manufacture of tobacco products for export.
Dr. Finlayson's letter touches on an interesting issue in
clinical practice. CMA recommends that tobacco-intervention
programs be created specifically for populations at risk; this
recommendation would cover all populations, not just the ones
mentioned by name in the policy summary. We certainly acknowledge
that patients receiving psychiatric care and people with
addictions are populations at risk (and, in fact, many also
belong to other at-risk populations), although policy-makers such
as governments do not tend to consider them a high-priority
group. However, as Finlayson points out, there is disagreement
within the profession as to the appropriate method of dealing
with tobacco use among patients receiving psychiatric care and
people with addictions. Finlayson's letter contributes valuable
evidence to the debate, and we welcome his input. We will follow
this issue with interest in coming years.
David J. MacKenzie, MD
CMA Council on Health Care and Promotion
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