The 5 A's of Smoking Cessation

Smoking Cessation in Public Health

Tobacco dependence remains the leading cause of preventable death in the United States, responsible for nearly one in five deaths. It also contributes significantly to chronic diseases such as cardiovascular conditions, COPD, asthma, and lung cancer.

While more than 70% of smokers express a desire to quit, many struggle to do so without proper guidance and motivation. Clinical support plays a crucial role, as brief counseling sessions with healthcare providers have been shown to increase quit rates by up to two-thirds. However, consistently implementing these interventions can be challenging in busy clinical environments. 

The 5 A’s Smoking Cessation Plan

The 5 A’s of Smoking Cessation, developed by the U.S. Public Health Service, is an effective tool for clinicians seeking to integrate tobacco treatment into routine patient care. This brief one-to-15-minute intervention helps healthcare providers guide patients who smoke through goal setting, motivational strategies, and action planning for quitting success. Patagonia Health’s Electronic Health Record (EHR) software simplifies the process with a built-in 5 A’s questionnaire, allowing local health departments and community health centers to seamlessly apply this model in their everyday workflows.

The 5 A’s Steps

Ask: At every visit, take a few minutes to inquire about your patient’s tobacco use and smoking habits.

Advise: Provide a clear, personalized message on the dangers of smoking and the benefits of quitting. Include education on the risks of second-hand smoke and encourage patients to share what they learn with others.

Assess: Determine the patient’s readiness to quit and discuss their level of motivation.

Assist: Offer counseling, pharmacotherapy, and motivational strategies to patients who demonstrate a willingness to make a quit attempt. Introduce the “5 R’s” to support behavior change:

• Relevance – Discuss why and how quitting is relevant to the patient.
• Risks – Discuss the risks they take by smoking
• Rewards – Identify the rewards they would benefit from by quitting
• Roadblocks – Address the roadblocks the patient will face and help find a way around them
• Repetition – Review the 5 A’s at every visit

Arrange: Schedule follow-up contact within a week after the quit date to reinforce the plan and provide ongoing support.

The Role of EHRs in Smoking Cessation

EHRs play a vital role in integrating and expanding smoking cessation interventions across healthcare settings. A trustworthy public health EHR will equip clinicians with intuitive tools that simplify workflows, enhance patient engagement, and improve outcomes for both individuals and communities.

• Screening and Documentation: Built-in prompts make it easy for providers to screen for tobacco use and record smoking history during routine visits, ensuring no opportunity for intervention is missed.
• Data Exchange between EHR and Quitline: Streamline patient referrals to Quitline and public health smoking cessation programs directly within your EHR and track the status of referral appointments. Progress updates from Quitline are automatically returned to the provider through CCD and HL7 data exchange protocols, reducing administrative burden and improving care coordination.
• Progress Tracking and Reporting: Monitor quit attempts and outcomes using built-in templates and reports that track counseling sessions, quit dates, and population-level results. These actionable insights help clinicians measure success and refine their approach to tobacco cessation.
• Integrated Data Capture Within Workflow: Data capture within the clinical workflow enhances treatment, education, and goal-setting processes. Providers can access the 5 A’s assessment form directly from the patient visit note screen and record smoking activity status within the social history section alongside other medical history details. Clinicians can set up treatment plans and goals and visualize progress through graphs, providing a clear picture of patient improvement over time.
• Patient Engagement and Education: Keep patients motivated through an Appointment Reminder and Recall System that automates follow-up text, voice, and email messages, reinforcing positive behaviors between visits. Communicate directly through the patient portal, where patients and providers can communicate via secure messaging.

By combining these capabilities, an EHR can enable providers to deliver coordinated, data-driven smoking cessation care that improves patient outcomes and advances community health initiatives.

Supporting a Smoke-Free Future

Tobacco dependence is a chronic, relapsing condition that often requires ongoing interventions and support to help people quit smoking. By integrating evidence-based frameworks like the 5 A’s with modern EHR tools, clinicians can enhance stop smoking programs and empower patients to achieve lasting results.

Health care providers play a vital role in reducing tobacco use through consistent, data-informed patient care. By leveraging EHR technology and proven frameworks, clinicians can help patients achieve lasting success through smoking cessation interventions, moving communities closer to a smoke-free future.