You Can Make a Difference!

Transcription

1 You Can Make a Difference! How to help your clients become tobacco free What Does Smoking Cost Us? One study estimates that cost savings of between $1,142 and $1,358 per pregnancy can be achieved for each pregnant smoker who quits. (Miller, D P, et al, Nicotine and Tobacco Research 3(1) 25 35, February 2001) 1

2 What Can I Do? Screening Implement an office wide system that ensures that for every patient at every visit, tobacco use status is asked about and documented. 2

3 Leadership Clinical sites should communicate to all staff the importance of intervening with users of commercial tobacco and should designate a staff person (e.g., nurse, medical assistant, or other clinician) to coordinate tobacco dependence treatments. Non physician personnel may serve as effective providers of tobacco dependence interventions. The 5 A Intervention ASK about Tobacco Use (Tobacco as a vital sign) ADVISE to stop ASSESS willingness to make an attempt ASSIST in the stop attempt ARRANGE for a followup visit Not since the polio vaccine has this nation had a better opportunity to make a significant impact in public health. David Satcher, MD,MPH US Surgeon General 3

4 Ask Systematically identify all tobacco users at every visit Advise Strongly urge all tobacco users to quit In a clear, strong, and personalized manner, urge every tobacco user to quit. Clear Important, cutting down not enough Strong Most important thing you can do to protect your health Personalized link to current symptoms and health concerns, social and or economic situations 4

5 Assess Determine willingness to make a quit attempt at the time If the patient is willing to participate in intensive treatment deliver such treatment or make a referral Modify for special populations Don t want to quit? provide motivational intervention Assist Aid the patient in quitting Recommend visiting doctor or talking to pharmacist for quit medication Set a quit date Counseling Skills training Anticipate Challenges Problem solving Social Support Intra treatment social support Extra treatment social support 5

6 Providing practical counseling Review past quit experience Success Triggers for relapse Anticipate triggers, challenges Alcohol can lead to relapse Other smokers limit exposure Individuals who may need more intensive therapy (more aggressive pharmacological therapy) Smoke more than a pack per day Smoke within 30 minutes of awakening Several withdrawal symptoms Early relapse History of psychiatric disorders Current or recovering dependence on alcohol or other drugs Presence of other smokers in the household 6

7 Medication Seven first line medications shown to be effective and recommended for use by the Guideline Panel: Bupropion SR Nicotine Gum Nicotine Patch Nicotine Lozenge Nicotine Inhaler Nicotine Nasal Spray Varenicline Prescription Over the Counter Over the Counter Over the Counter Prescription Prescription Prescription PHS Resources to Help you Succeed! 7

8 Michigan Patient Resources American Cancer Society offers printed material and sponsors the Great American Smokeout on the third Thursday in November. Call American Lung Association offers quit smoking classes, printed material, cessation website. Call Telephone referral and cessation advice is available by calling National Cancer Institute offers a quit kit and telephone advice at U QUIT. HHS/NCI/NIH offers SmokefreeTXT, a free mobile text messaging service designed for adults and young adults. Michigan Patient Resources Nicotine Anonymous at QuitNet Online Smoking Cessation Try to Stop: A website offering an online quit smoking program called Quit Wizard. BecomeanEX: A website offering an online quit smoking program. U.S. Public Health Service offers a free booklet, You Can Quit Smoking Now! Call QUITNOW. 8

9 The Michigan Tobacco Quitline Tobacco Quitlines Work in conjunction with clinician intervention. Can provide the treatment intensity that often cannot be provided in a clinical setting due to time constraints. Increase access to treatment and reduce barriers. Can provide assistance in multiple languages. Can provide assistance before and after normal business hours. 9

10 The Michigan Tobacco Quitline QUIT NOW ( ) (TTS) Calls answered between 7 am to 1 am EST 7 days a week Answering machine after hours (call backs in 24 hours or less) Provides: Referrals to local programs One time counseling Intensive counseling proactive sessions Unlimited reactive calls for one year Free NRT to the uninsured Self help materials Text messaging Online coaching Quitline Counselors Trained in motivational interviewing techniques. Counselors have a minimum of a bachelors degree. Counselors receive clinical supervision from a licensed psychologist. A Medical Director is on staff and provides oversight. Trained in the difference between commercial and traditional/ceremonial tobacco use. 10

11 Quitline Service Delivery Every participant is viewed as an unique participant Coach assesses motivation and works with caller according to where they are in stages of change All calls are scheduled by the participant in order to accommodate their schedule All participants can call into to the Quitline 7 days/week to discuss any issue at no additional cost Cultural Diversity Training Cultural Competency is first addressed when training new hires. Continuing education on cultural diversity is required throughout the year National Jewish Health is committed to employing members of other cultures to conduct diversity trainings. Customer Service Program: A core value for all Quitline staff is respect for yourself and others 11

12 Michigan Tobacco Quit Line Services All Michigan Callers Receive Information & Referral Text Messaging Online Coaching Medicaid, Veterans & Youth under 18 Counseling 4 sessions for general enrollees 9 sessions for prenatal Medicare, Uninsured, Prenatal, Cancer Patients & County Health Plan Counseling (same as above) Up to 8 weeks of nicotine patch, gum or lozenge Quitline Online 12

13 Prenatal Incentives Studies have shown that incentives are effective in the prenatal population. Prenatal Calls For each counseling call an enrollee completes with her coach, she will receive a $5 Visa gift card. (5 in total) Postpartum Calls For each counseling call completed after delivery, the enrollee will receive a $10 gift Visa gift card. (4 in total) Michigan Quit Line Fax Referral Form for Health Care Providers 13

14 Fax Referral Process Fax the completed form to Patient is called within 24 hours of receipt or based on the preferred times indicated by the participant 3 attempts to reach the patient based on the preferred times indicated on the fax referral form If no preferred times are indicated, we call the patient at 24 hours, 3 days and 10 days. 14

15 How can you make fax referrals to the Quitline more successful? Make sure to fill out patient contact information completely. Make sure that the patient is prepared to receive a call from the Quitline: QUIT-NOW ( ) Have the patient indicate their preferred times to be reached by the Quitline. Provider should sign for Nicotine Replacement Therapy on every form if the patient has a health condition requiring MD Consent. National Jewish Health Website Screenshot Click Here for Fax Referral Form 15

16 Outcomes Report for Fiscal Year 2012 Total enrollees: 5,614 Pregnant enrollees: 336 Tobacco abstinence rates post enrollment for prenatal 3 months: 42.25% 6 months: 35.48% 12 months: 33.33% *Note response rate for statistical significance is 200. This was not met for the prenatal group. Contact Information Karen S. Brown Public Health Consultant Michigan Department of Community Health Brownk34@michigan.gov Or visit the Quitline at: 16