Best Practices in Tobacco Treatment IDN

Transcription

1 Best Practices in Tobacco Treatment IDN

2 Objectives

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8 Project SCUM was a plan proposed in 1995 by R. J. Reynolds Tobacco Company (RJR) to sell cigarettes to members of the "alternative lifestyle" areas of San Francisco, in particular the large number of gay people in the Castro and homeless people in the Tenderloin.

9 Physicians under-treat smokers AAMC-Legacy Survey: Physician Behavior and Practice Patterns Related to Smoking Cessation, 2007

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11 Opportunity for providers Ending the Tobacco Problem: A Blueprint for the Nation. PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

12 Brief Interventions are effective! PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

13 Brief interventions PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

14 Brief interventions PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

15 Ask and Act

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17 Since the implementation of a new electronic medical record (EPIC) in November referrals average 51 per month

18 Cheshire Tobacco Treatment Program: After a patient is referred: Patient scheduled for initial 45 minute assessment of tobacco use history Carbon monoxide screen done Plan created with patient if they are interested We provide discounts on patches, gum and lozenges We interface with providers to order prescriptions like inhalers, nasal sprays, Chantix or prescription NRT if needed Follow up appointment scheduled Patient may attend free monthly Tobacco-Free or Trying to Be Support Group Monadnock Family Services has started a tobacco treatment program which we are happy to support Visit documented in EMR

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20 Pharmacotherapy

21 Pharmacotherapy PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

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23 First-line pharmacotherapy PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

24 First-line pharmacotherapy α β

25 Factors to consider when prescribing PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

26 Bupropion SR Rx for Change Pharmacologic Product Guide

27 Nicotine gum Rx for Change Pharmacologic Product Guide

28 Nicotine inhaler Rx for Change Pharmacologic Product Guide

29 Nicotine nasal spray Rx for Change Pharmacologic Product Guide

30 Nicotine patch Rx for Change Pharmacologic Product Guide

31 Nicotine lozenge Rx for Change Pharmacologic Product Guide

32 Varenicline Rx for Change Pharmacologic Product Guide

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34 Long term pharmacotherapy

35 Some patients have special needs.

36 Combining medications PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

37 Counseling PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

38 Deep Breathing(simulates smoking, relieves anxiety) Do Something Else Distraction Delay (for a minute, hour, day) Drink Water We offer comfort kits to patients with gum, lollipops, rubber band, straws or toothpicks, phone numbers which anyone can re-create)

39 Patients unwilling to quit Use brief intervention to promote motivation (motivational interviewing) Patients unwilling to quit may: Lack information about harmful effects or benefits of quitting Lack financial resources Have fears or concerns about quitting Think they can t quit PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

40 Quit-lines

41 Medicare

42 Medicare

43 Medicare

44 Private Insurers

45 Medicaid NH Medicaid covers over the counter medications (with a prescription), Varenicline, Bupropion, nicotine inhaler and nasal spray. Prescription cannot be written for brand name. Must be written for Medicaid covered nrt. The Henry J. Kaiser Family Foundation. State Medicaid Program Coverage of Tobacco Dependence Treatments by Type of Coverage

46 Summary of a few key recommendations

47 Key Recommendation PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

48 Key Recommendation PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

49 Key Recommendation PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update

50 Power of intervention Partnership for Prevention. Preventive Care: A Profile on Use, Disparities, and Health Benefits: 2007.

51 Ask your patients if they use tobacco. Act to help them quit QuitNow

52 Questions?

53 THANK YOU!

54 To view YouTube Videos of Patients: