Better Screening: Electronic medical records consistently under-report tobacco use. Identification of all forms of tobacco use is an essential first step in treatment.

Consistent advice to quit, every visit: Physician billing for tobacco cessation for 3 minutes (CPT 99406) is not commonly used, yet can be billed up to eight times a year, even if patients are not making a quit attempt.

Offer evidence-based treatment at every visit. Medication and counseling are available at no cost. Varenicline is 50% more effective than other medications

Offer a trial of quitting:

Consider self-medication for underlying mental illness as a reason for relapse

Schedule a follow-up visit for patients making a quit attempt.

Consider using two or more medications for patients who relapse.

Refer to a center of excellence:

Consider Harm Reduction: for adults who have consistent difficulty in quitting