Brief Tobacco Intervention Policy

Transcription

1 1 P a g e Brief Tbacc Interventin Plicy An Implementatin Guide fr Healthcare Prviders 2016

2 2 P a g e Table f Cntents Intrductin: The Imprtance f Brief Tbacc Interventin Plicy in Health Clinic...p. 3 Arkansas Tbacc Data p. 4 Best Practices fr Tbacc Cessatin...p. 5 Adpting the Plicy...p. 7 Cmmunicating and Implementing the Plicy...p. 8 APPENDIX..... p Appendix A: Sample BTI Plicy....p. 9 Appendix B: Arkansas Tbacc Quitline Infrmatin...p. 12 Appendix C: 2A s and R. p. 13 Appendix D: Chart Sticker Template.....p. 14 Appendix E: ATQ Fax Referral Frm and Instructins..p. 15 Appendix F: Tbacc Cessatin Medicatin Chart... p. 17 References...p. 18

3 3 P a g e Intrductin: The Imprtance f Brief Tbacc Interventin Plicy in Health Clinics The majrity f Americans are dying preventable deaths. Tbacc use remains the leading cause f preventable death in the United States. In Arkansas, 5,800 adults die each year frm illnesses caused by their wn tbacc use. 1 Majr tbacc preventin and cessatin effrts are required t reverse the tbacc epidemic. Healthcare prviders are in an excellent psitin t make a huge impact n cessatin effrts in Arkansas by implementing measures t prevent and treat tbacc dependence. Health prfessinals have several rles t play in cmprehensive tbacc cntrl effrts, including rle mdel, clinician, educatr, scientist, leader, pinin-builder, and alliance builder. All health prfessinals shuld at least: Serves as tbacc-free rle mdels fr the general public; and Address tbacc dependence as part f yur standard f care practice Healthcare prviders, especially primary care physicians, can be key in helping tbacc users quit. If all primary care physicians rutinely ask abut tbacc use and advise tbacc users t stp, they have the ptential t reach mre than 80% f all tbacc users per year; trigger 40% f cases t make a quit attempt; and help 2-3% f thse receiving brief advice quit successfully. The US Preventin Services Task Frce (USPSTF) has recgnized the effectiveness f such cessatin services by giving tbacc cessatin an A grade and recmmending that all clinicians ask all adults abut tbacc use and prvide tbacc cessatin interventins fr thse wh use tbacc prducts. 2 Hwever, healthcare prviders have many barriers they have t vercme in rder t effectively ffer tbacc cessatin t their patients. The main, reccurring barrier that health care clinics have t vercme is lack f time. Healthcare prviders time with patients is already limited, s many have cncerns that they lack the time t bth treat patients and effectively help their patients quit tbacc. This tlkit is designed t help healthcare clinics address this barrier head n thrugh brief tbacc interventin. Brief tbacc interventin is a technique that gives healthcare prviders a quick (3 minutes r less) but systematic apprach t helping their patients stp using tbacc. This tlkit hlds the resurces and infrmatin needed t help healthcare clinics adpt and efficiently implement brief tbacc interventin plicies within their facilities. If healthcare prviders in Arkansas cntinuusly talked with their patients abut their tbacc use and advised them t quit, they culd ptentially save r at least prlng the lives f thusands f Arkansans. Adpting and implementing a brief tbacc interventin plicy is an excellent first step fr clinics lking t decrease and eliminate the tll tbacc use has n the patients they serve. 1 Campaign fr Tbacc Free Kids, 2 US Preventin Services Task Frce (USPSTF),

4 4 P a g e Arkansas Tbacc Data 5,800 Arkansans die every year frm their wn smking. Adult Smking Rate US 16.8% Arkansas 24.7% Arkansas US PORTION COVERED BY THE STATE MEDICAID PROGRAM: $293.1 MILLION ANNUAL HEALTH CARE COSTS IN ARKANSAS DIRECTLY CAUSED BY SMOKING: $1.21 BILLION Fr every $1 invested in the Arkansas Tbacc Quitline, the peple f Arkansas save $28 in future healthcare csts. Surces: Campaign fr Tbacc Free Kids, Arkansas Department f Health: Tbacc Preventin and Cessatin Prgram,

5 5 P a g e Best Practices fr Tbacc Cessatin The Public Health Service f the United States Department f Health and Human Services develped best practice guidelines fr prviders in assessing tbacc users and rendering effective tbacc dependence interventins. The guidelines encurage prviders t utilize the 5 A s mdel fr treating tbacc use and dependence: Ask all patients abut their tbacc use at every visit Advise all patients wh use tbacc t quit Assess their readiness t make a quit attempt Assist patients with a quit plan Arrange fr a fllw-up cntact r a referral Fr clinics that lack the resurces and time t perfrm the 5As mdel, it is recmmended that an abbreviated mdel which is referred t as the 2A s and R mdel. In this mdel prviders Ask all patients if they use tbacc. Advise tbacc users t quit thrugh persnalized messages, and then Refer tbacc users t apprpriate cmmunity cessatin services. In Arkansas, yu can easily refer patients t the Arkansas Tbacc Quitline. The guidelines identify 10 key findings that prviders shuld cnsider: 1. Tbacc dependence is a chrnic disease ften requiring repeated interventin and multiple attempts t quit. Hwever, effective treatments exist that can significantly increase rates f lng-term abstinence. 2. Prviders and delivery systems shuld cnsistently identify and dcument tbacc use status and treat every tbacc user seen in a healthcare setting at every visit. 3. Tbacc dependence treatments are effective fr all patient ppulatins. Prviders shuld encurage every patient willing t make a quit attempt t use the recmmended cunseling treatments and medicatins. 4. Brief tbacc dependence treatment is effective. Prviders shuld ffer every patient wh uses tbacc at least the brief treatments shwn t be effective. 5. While cunseling and medicatin are effective by themselves, they are mre effective used in cmbinatin. 6. Individual, grup and telephne cunseling are effective and their effectiveness increases with treatment intensity. Tw cmpnents f cunseling are especially effective: Practical Cunseling (prblem slving/skills training) Recgnize what events, internal states, r activities increase the risk f smking r relapse. Identify and practice cping r prblem-slving skills t cpe with situatins that increase risk f smking and relapse. Prvide the basic infrmatin abut smking, its harmfulness, and abut successful quitting.

6 6 P a g e Scial Supprt Delivered as Part f Treatment Encurage quit attempts. Cmmunicate care and cncern. Encurage the patient t talk abut the quit attempt. 7. There are several effective medicatins fr tbacc dependence treatment. Prviders shuld prmte their use by all patients attempting t quit smking, except when medically cntraindicated. (See Medicatin Table in Appendix F) 8. Telephne QUITLINE cunseling is effective! Prviders shuld, if nthing else, ffer the Arkansas Tbacc Quitline services t all patients ver the age f thirteen wh are interested in quitting. (Fr mre infrmatin abut the Arkansas Tbacc Quitline see Appendix B) 9. Fr patients unwilling t make a quit attempt, mtivatinal strategies shuld be used t address the risks f cntinued tbacc use, the rewards t stpping tbacc use, and the radblcks t quitting. These interventins shuld be repeated every medical visit. 10. Treating tbacc dependence is bth clinically effective and cst-effective. (Adapted frm MDwise, Tbacc Cessatin Tlkit Fr Prviders, 2013, MDwise.rg/wellness/smkefree)

7 7 P a g e Adpting the Plicy Plicy Develpment and Implementatin Timing the plicy. Select an implementatin date with significance. An excellent idea is t chse natinal r statewide tbacc bservance dates, like The Great American Smke Out in Nvember r Kick Butts Day in March, as the implementatin date. It may take mnths f bard meetings until members agree a plicy is needed. Listen carefully t cncerns and prvide a persnal stry frm a patient abut hw smking has affected their life. Cmmunicate with staff at each staff meeting beginning as many mnths in advance f implementatin as pssible. Take the time t educate staff n the rganizatin s reasns fr adpting the plicy, which eventually will becme talking pints they can use in their cnversatins. Wrking backwards frm the effective date, create a schedule f activities and cmmunicatins t include: Special staff discussins abut the plicy Bard meeting abut the prpsed plicy and request t begin cmment perid Written ntificatin abut plicy Bard meeting t apprve plicy and the implementatin plan Creatin f resurce packets fr patients Plicy start date Signage reminders Plicy reminders fr staff Plicy enfrcement discussins at every staff meeting Staff invlvement and cmmunity partners. Invlve staff in the develpment and enfrcement f the plicy. The staff can help identify ptential barriers t implementing and enfrcing the plicy, as well as ways t vercme the barriers. It is als a gd idea t invlve cmmunity calitins and ther partners that have helped ther clinics adpt a similar plicy. Cnsider starting with a pilt site. Explre training pprtunities. Staff members will need t be trained n Brief Tbacc Interventin befre implementing the plicy. Take the time t research ptential BTI training pprtunities that fit the needs f the clinic. Explre available cessatin prgrams. Befre implementatin, healthcare prviders in yur clinic will need t knw where t refer their patients fr tbacc cessatin. It is imprtant t d research t identify prgrams r rganizatins in the area that ffer tbacc cessatin services. Arkansas ffers a statewide cessatin prgram via telephne called the Arkansas Tbacc Quitline.

8 8 P a g e Cmmunicating and Implementing the Plicy Implementing brief tbacc interventin plicies can be challenging. Withut effective cmmunicatin, especially with yur clinic staff, the plicy will be difficult t enfrce. The fllwing is a list f cmmunicatin ideas and strategies t ensure all staff are aware f the plicy, understand the ratinale behind the plicy, and are actively implementing the plicy with each patient. With Staff Discuss the plicy at staff meetings. Take the time t explain why the clinic has chsen t implement the plicy and ensure yur staff that they will be prvided training n brief tbacc interventins. Pst signage arund the ffice reminding the staff t ask each patient abut their tbacc use. Send s ccasinally reminding the staff t ask patients abut their tbacc use. Include tbacc use and cessatin questins n intake and assessment frms Add tbacc use t vitals fr every visit Add chart stickers dcumenting tbacc usage It is als imprtant t let patients knw that the clinic is in a psitin t help them stp their tbacc use. Yu can educate patients by: Put up psters in the waiting rm and in each exam rm that let patients knw that the clinic can help them quit tbacc, and encuraging them t get help t quit. Offer educatinal infrmatin like brchures and Arkansas Tbacc Quitline cards in the waiting rm fr patients t lk at befre their visit. Psters, brchures, quit cards and ther educatinal materials can be rdered r dwnladed at

9 9 P a g e APPENDIX A Sample BTI Plicy Health Clinic Brief Tbacc Interventin (BTI) Plicy Plicy Statement: Wellness staff will prvide brief (< 3 minutes) clinical interventin t clients wh smke r use any tbacc prduct AND are ready t quit. Plicy title is Brief Tbacc Interventin fr Tbacc Cessatin. Prcedures: 1. At each encunter in the Clinic, staff will prvide brief tbacc interventin. 2. Clinic staff will fllw the prtcl ASK-ADVISE-REFER (2A s & R), a mdified versin f the 5- A s prtcl recmmended in the U.S. PHS Clinical Practice Guideline, fr the general ppulatin f tbacc users as utlined in Appendix 1. a) The prvider will ASK and dcument in the client s medical r nutritinal recrd if the client uses tbacc prducts and the type f prduct used. b) Fr all tbacc users, the prvider will ask and dcument in the client s medical r nutritinal recrd the client s readiness t quit. c) Fr all tbacc users, the prvider will ADVISE every tbacc user t quit. d) If the client is willing t make a quit attempt, the prvider will REFER the client t the Arkansas Tbacc Quitline and will cmplete a Fax Referral Frm. The frm is then faxed t the Arkansas Tbacc Quitline fax number, , s Quit Cunselrs can cntact the client. e) Clients wh are nt ready t quit shuld be prvided mtivatinal interviewing and resurce materials. 3. Clients expressing an interest in pharmactherapy, such as nictine inhaler, nictine nasal spray, buprpin SR and varenicline, shuld be advised t cnsult their primary care prvider. Respnsibility: Physicians, Dentists, Nurses, Mental Health Prviders, Health Educatrs, Scial Wrkers, Nutritinists, Nutritin Educatin Specialists. Date f Apprval: (NOTE: Prviders have until, 2015, t fully implement this plicy.) References: See Appendix 2 fr verview f best practice recmmendatins. AAFP Summary f Recmmendatin fr Clinical Preventive Services, Tbacc Use, Clinical Summary f U.S. Preventive Services Task Frce Recmmendatin, Cunseling and Interventins t Prevent Tbacc Use and Tbacc-Caused Disease in Adults and Pregnant Wmen, Agency fr Healthcare Research and Quality (AHRQ),

10 10 P a g e Appendix 1 General Ppulatin Tbacc Cessatin Prtcl Prtcl Steps Interventin Strategy Verbal Prmpts Step 1: ASK abut tbacc use. Identify and dcument tbacc use status fr every patient at apprpriate visits per prgram guidelines. "D yu currently use, r have used in the last 30 days, any tbacc prducts, such as smking, smkeless tbacc, r even electrnic nictine devices, such as e- cigarettes?" Step 2: ADVISE t quit. In a clear, strng, and persnalized manner, urge every tbacc user t quit. "Quitting tbacc is the mst imprtant thing yu can d t prtect yur health. I strngly encurage yu t quit." Step 3: REFER after Assessment. Assess willingness t make a quit attempt. Refer fr cunseling QUIT-NOW Is the tbacc user willing t make a quit attempt at this time? If the client is willing t make a quit attempt at that time, cmplete and fax a Fax Referral Frm t the Arkansas Tbacc Quitline. "Are yu willing t give it a try?" "If yu're ready t quit, we're ready t help. Our state perates a free cunseling Quitline t ffer yu assistance." If they are nt ready, prvide them with self-help materials and ffer yur future supprt. When yu are ready t quit, I am here t supprt yu and have resurces that can help yu. Nte 1: Screening fr current r past tbacc use will result in fur pssible respnses: (1) the client uses tbacc and is willing t make a quit attempt at this time; (2) the client uses tbacc but is nt willing t make a quit attempt at this time; (3) the client nce used tbacc but has since quit; and (4) the client never regularly used tbacc. Nte 2: Fr patients unwilling t make a quit attempt at the time, prvide Quitline resurces and address tbacc dependence and willingness t quit at next clinic visit. PHARMACOTHERAPY Recmmend fr medicatin. If the client asks abut pharmactherapy and a licensed physician is nt available at the clinic, recmmend that the tbacc user talk with his r her primary care physician wh can prescribe ne f the seven FDA apprved first-line medicatins. "There are a number f medicatins available that can help yu be successful in quitting. Yu need t talk with yur dctr t see what might be best fr yu."

11 11 P a g e Appendix 2 Practice Recmmendatin Clinical interventin with all tbacc users is a best practice recmmendatin f the U.S. Public Health Service. The U.S. Preventive Services Task Frce (USPSTF) strngly recmmends that clinicians screen all adults fr tbacc use and prvide tbacc cessatin interventins fr thse wh use tbacc prducts. The American Academy f Family Physicians (AAFP) strngly recmmends that clinicians screen all adults fr tbacc use and prvide tbacc cessatin interventin fr thse wh use tbacc prducts. The AAFP strngly recmmends that clinicians screen all pregnant wmen fr tbacc use and prvide 5-15 minutes f smking cessatin cunseling using messages and self-help materials tailred fr pregnant smkers. Strength f the Practice Evidence Defined Strngly Recmmended: Gd quality evidence exists which demnstrates a substantial net benefit ver harm when tbacc users are prvided cunseling and pharmactherapy t quit. The interventin is cst effective and acceptable t nearly all patients.

12 12 P a g e APPENDIX B Arkansas Tbacc Quitline Infrmatin One f the mst imprtant calls a tbacc user can make is t the Arkansas Tbacc Quitline at QUIT-NOW ( ). It is cnfidential, and it is free. When tbacc users call, they will receive: Free, cnfidential, nn-judgmental expert supprt frm a Quit Cunselr t help make a plan t quit tbacc. Onging Quit Cunselr supprt via phne r nline, tailred t the specific needs f all tbacc users, including smkeless tbacc users. Wmen wh are pregnant are eligible fr a specialized cessatin prgram with additinal benefits. Unlimited access t Web Cunselr, an interactive, nline cmmunity that ffers tls t quit, scial supprt and infrmatin abut quitting. Custmized, mtivatinal s sent thrughut the quitting prcess. Help with identifying the best cessatin aid, as well as dse and duratin. Sme aids can be mailed directly t the tbacc user s hme, including free patches and lzenges (while supplies last). Referral t lcal cmmunity resurces and/r benefits ffered thrugh emplyers r health plans. Printed Quit Guides a series f wrkbks that ffer guidance and supprt thrughut the quitting prcess. The Arkansas Tbacc Quitline is available seven days a week, 24 hurs a day. Services are available in English, Spanish and additinal languages as needed, including Marshallese. Fr additinal infrmatin r t rder psters, brchures, and quit cards, visit

13 13 P a g e APPENDIX C 2A s and R Fr additinal infrmatin r t rder resurce materials, visit

14 14 P a g e APPENDIX D Chart Sticker Template (Avery Labels #5162 and #5262 (1.33"x4"); frm Next Generatin Tbacc Cntrl Alliance Health Care Prvider s Tlkit fr Prviding Smking Cessatin Services) (Adapted frm Behaviral Health & Wellness Prgram, University f Clrad Denver, Tbacc-Free Tlkit fr Cmmunity Health Facilities)

15 15 P a g e APPENDIX E ATQ Fax Referral Frm and Instructin

16 16 P a g e Instructins fr Cmpleting the Arkansas Tbacc Quitline Fax Referral Frm The ADH Fax Referral Frm is used t refer a patient wh smkes r uses ther tbacc prducts t the Arkansas Tbacc Quitline via a cnfidential fax referral system. The fllwing steps must be fllwed prir t sending a fax referral t the Quitline. General: 4. Clinic prvider must fllw the prtcl in the Tbacc Cessatin Interventin Plicy (2A s & R) befre referring a client t the Quitline. External prviders are als encuraged t fllw this prtcl. These steps are: Ask abut tbacc use; Advise t quit and ask if client is ready; Refer t Quitline fr cessatin cunseling and recmmend client sees primary care physician fr cessatin medicatin guidance. Prvider Infrmatin: 5. Enter the date the frm is faxed t Quitline. 6. Enter clinic name as n all Fax Referral Frms. The clinic name must be stated exactly as such fr state reprting purpses. 7. Enter clinic address and name f a primary cntact persn fr the clinic. 8. Enter clinic s fax number and telephne number f primary cntact persn. 9. Indicate clinic s HIPAA cmpliancy. 10. Enter name f client s physician r health care prvider. Patient (Client) Infrmatin: 11. Check gender f client. 12. Check if client is pregnant. 13. Enter patient/client s name, date f birth, and full mailing address. 14. Enter patient s primary and secndary telephne numbers, including area cdes and the type f numbers listed. 15. Check client s language preference. 16. Check type f primary tbacc use. If use includes electrnic nictine devices (ENDs) please nte. 17. CLIENT MUST AGREE TO RECEIVE A CALL FROM THE QUITLINE. If s, client must write his/her initials n the line prir t the statement: I am ready t quit tbacc and I request the Arkansas Tbacc Quitline cntact me t help me with my quit plan. 18. If client is willing t have the Quitline leave a message n their telephne, client must write his/her initials n the line prir t the statement: I give my permissin t the Arkansas Tbacc Quitline t leave a message when cntacting me. 19. PATIENT/CLIENT MUST SIGN AND DATE THE FORM. 20. PATIENT/CLIENT MUST CHECK THE BOX OF THE BEST 3-HOUR TIME FRAME FOR A QUITLINE REPRESENTATIVE TO REACH HIM OR HER. 21. PATIENT/CLIENT MUST CHECK THROUGH WHICH NUMBER THEY PREFER TO RECEIVE THE CALL. 22. PATIENT/CLIENT MUST RECEIVE A COPY OF THE FORM. Final Steps: 23. Fax the cmpleted Arkansas Tbacc Quitline Fax Referral Frm t the Quitline Fax Number listed at the tp f the frm. Cpy ges t client and riginal ges in health recrd. 24. Once faxed, the frm is filed accrding t the current health recrd frmat. Accrding t the Arkansas Medical Sciety, All recrds required by the federal Health Insurance Prtability and Accuntability Act (HIPPA) must be retained a minimum f six years. It is a recmmendatin f the AMS that physicians keep patient medical recrds fr at least ten years frm the date f the last treatment.

17 17 P a g e APPENDIX F Tbacc Cessatin Medicatin Chart *Surce: Tbacc-free Maine,

18 18 P a g e References 1. Campaign fr Tbacc Free Kids, 2. US Preventin Services Task Frce (USPSTF), StatementFinal/tbacc-use-in-adults-and-pregnant-wmen-cunseling-andinterventins 3. MDwise, Tbacc Cessatin Tlkit Fr Prviders, and%20resurces/tlkits/tbacc_cessatin_tlkit.pdf 4. Behaviral Health & Wellness Prgram, University f Clrad Denver, Tbacc- Free Tlkit fr Cmmunity Health Facilities, csf.edu/files/dwnlads/tlkits/tf_plicy_tlkit_0713.pdf 5. Arkansas Department f Health: Tbacc Preventin and Cessatin Prgram, t.aspx 6. Stamp Out Smking, 7. Tbacc-free Maine, d2011refrmattedfb.pdf