Follow Up to Smoking Cessation

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Beverley Moody
6 years ago
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Follow Up to Smoking Cessation Laura Brandon, MPH Quality Improvement Coordinator SC QTIP Disclosures Laura Brandon, MPH I have no relevant financial relationship

1 Follow Up to Smoking Cessation Laura Brandon, MPH Quality Improvement Coordinator SC QTIP Disclosures Laura Brandon, MPH I have no relevant financial relationship with the manufacturer(s) of any commercial product(s) We do not intend to discuss an unapproved/investigative use of a commercial product/device in our presentation 1

2 Outline Introduced Cease at Summer 2017 Learning Collaborative Data collection via QIDA August December Implementation story from AnMed Health Anderson Pediatrics CEASE Training- Summer 2017 (Clinical Effort Against Secondhand Smoke Exposure) Learned the hazards of second and third hand smoke exposure. Pediatric visits create a teachable environment for parents. 3 steps to CEASE Ask: universal screen for exposure, at every visit, Flag the provider Assist: motivational interviewing, providers prescribes NRT (advised by AAP and AMA) Connect: refer to SC Quitline Learned how to prescribe NRT and about combination therapy Covered billing codes 2

3 Please bring to the exam room to review with the doctor Step 1: For the parent/patient to fill out Have you smoked a cigarette or vaped, even a puff, in the last 30 days? Yes No Would you like to receive FREE resources from the Tobacco Quitline? Yes No Not sure Would you like nicotine patch and gum to help you cut down or quit smoking? Yes No Not sure Document Tobacco Use/Exposure Tobacco users: Mother Father Patient Other Smoke-free home rule: Yes No Smoke-free car rule: Yes No No car Document Services Provided Prescription given for patch and/or gum to: Enrolled in the Quitline Enrolled in SmokefreeTXT Set a quit date for Step 2: For office use (EMR Entry) Code to document parental tobacco use/assistance (Toxic effect of tobacco) Code Z77.22 to document any suspected tobacco smoke exposure Code F to document teen tobacco use/assistance (Nicotine dependence) TEAR HERE TEAR HERE TEAR HERE TEAR HERE TEAR HERE Call for free help quitting OR Text the word QUIT (7848) to IQUIT (47848) for free help. Center for Pediatric Medicine 20 Medical Ridge Dr. Greenville, SC (864) Text the word QUIT (7848) to IQUIT (47848) for free help OR Call for free help quitting. Center for Pediatric Medicine 20 Medical Ridge Dr. Greenville, SC (864) Name Date Name Date Address D.O.B. Nicotine patch (check strength) 21mg 14mg 7mg Apply 1 patch for hours each day Dispense 2 months supply Refill NR Prescription is void if more than one (1) prescription is written per blank. May substitute Address D.O.B. Nicotine gum 4mg Chew one piece every 1-2 hours Dispense 2 months supply Refill NR Prescription is void if more than one (1) prescription is written per blank. May substitute Quality Improvement Data Aggregator (QIDA) 4 Surveys 3-6 Month olds 24 Month olds Persistent Asthmatics Teenagers (13-18) 3-6 Month Survey and Asthma survey asked Was the patient screened for smoke exposure? for 6/7 cycles (started in January 2017) Starting in August ALL surveys were asked: Was the family (or patient) screened for tobacco exposure? Was the screen positive? Was the family given advice to quit? Were cessation strategies discussed? (including referral to the quit line) 3

4 24 month olds October December Total "Yes" Total Charts Total % Families Screened for Tobacco Use 70% 82% % Positive Tobacco Screens 13% 12% % Family Given Advice to Quit 23% 33% % Cessation Strategies Discussed 12% 17% % Teens September November Total "Yes" Total Charts % Families Screened for Tobacco Use 88% 90% % Positive Tobacco Screens 15% 11% % Family Given Advice to Quit 40% 50% % Cessation Strategies Discussed 23% 13% % 6-9 Month Olds September November Total "Yes" Total Charts % Families Screened for Tobacco Use 96% 95% % Positive Tobacco Screens 14% 11% % Family Given Advice to Quit 32% 54% % Cessation Strategies Discussed 26% 31% % 4

5 Persistent Asthma October December Total "Yes" Total Charts Total % Families Screened for Tobacco Use 66% 84% % Positive Tobacco Screens 19% 19% % Family Given Advice to Quit 25% 32% % Cessation Strategies Discussed 16% 11% % But, How did we do this? As told by Dr. AnMed Pediatrics QTIP team decided to pilot CEASE screening form with Dr. Clark. (in September) Presented form to AnMed for printing: AnMed got back to us that form would have to be changed, including scripts could not be a bottom of form (but would print separate scripts pads for gum and patch), and would have to be approved by forms committee before we could implement pilot October- started pilot w/o script pads found successful work flow w/ using model for improvement/ PDSA cycles. December- used lessons learned from pilot to spread to rest of practice. 5

6 Lessons Learned from Dr. Clark Very little push back from parents, one instance of questionable answers, found out the parents was mid quit and used the opportunity to celebrate with the family. Families were thankful to be offered cessation help! Found that insurance won t pay cessation counseling AND other billings for the day. Having a nurse do follow up calls to families who expressed desire to quit was helpful. EMR adjustments would be helpful for effective documentation 6

The Kentucky Department for Public Health University of Kentucky College of Nursing Local Health Department Tobacco Cessation Survey, 2001

The Kentucky Department for Public Health University of Kentucky College of Nursing Local Health Department Tobacco Cessation Survey, 2001 1. Are you or other health department staff involved in providing tobacco cessation programs? 2. If Yes, what programs do you provide? a. Fresh Start (American Cancer Society) b. Freedom from Smoking (American