Treatment issues: towards a stepped-care model

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Abstract
The winds of change in health care in the US place us on the edge of a decade of opportunity to make a difference in prevention of chronic diseases related to lifestyle. The philosophy that prevention be fully integrated into mainstream health care practice is central to these winds of change. We must ensure the optimisation of health care practice in terms of quality of life, quality of services, access, and cost for all citizens. This presentation focuses on the essential elements to be considered in making wise choices about comprehensive treatment of tobacco dependence. My goals for this presentation are threefold: First, I will highlight general conceptual principles. Second, I will provide specific recommendations for optimal treatment of tobacco dependence using a stepped-care approach. Third, I conclude with an exploration of selected concerns about barriers to treatment implementation, service delivery, and to standards of care and cost- effectiveness.