Alberta Health System Tobacco Cessation Model. Canadian Public Health Association Conference Edmonton, June 14, 2012 LC 12-42

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1 Alberta Health System Tobacco Cessation Model Canadian Public Health Association Conference Edmonton, June 14, 2012 LC

2 Learning Objectives 1. Recognize the potential challenges and opportunities in developing and implementing a health systems approach to treating tobacco dependency. 2. Understand proposed care pathways and resources for management of tobacco dependence and nicotine addiction across the healthcare continuum 2

3 Alberta Health Services Alberta Health Services is the largest health care organization in Canada 99,000 skilled and dedicated health professionals and support staff 17,000 volunteers and 7,675 physicians Serving 3.7 million Albertans and many residents of southwestern Saskatchewan, southeastern British Columbia and the Northwest Territories We became one entity April 1, 2009, bringing together 9 health regions and 3 provincial entities 3

4 Quick Facts About AHS 98 acute care hospitals; 5 stand-alone psychiatric facilities 9,700 acute care/sub-acute care/psychiatric beds* 20,000 long-term care/ supportive living beds* 1300 addiction treatment beds 180 palliative and hospice beds 6 urgent care centres 300,000 emergency calls and transfers between facilities * As of March 31,

5 Tobacco and our Healthcare System Tobacco use increases the demand for health services or prolongs the recovery period/hospital stay thereby reducing system capacity 5

6 Impact of Tobacco Use on Healthcare Systems Risk of hospitalization for current smokers is 80% higher for year olds. Current daily smokers excess hospital days ranged from 1.5 days at yrs to 6 days for yrs. 194,172 excess hospitalized days for smokers and former smokers < 5 years aged Tobacco use cost Alberta $1.8 billion (2002) $470.6 million in direct health care costs BUT we did not have a consistent approach to assessing, advising and assisting Figures estimated based on Alberta portion of Canadian population ~ 11% of Canadian figures from Wilkins, Shields & Rotermann, Statistics Canada,

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8 Tobacco & Smoke Free Environments Policy AHS Policy (#FM-03) took effect on April 1 st, Outlines the health region s commitment to a smoke and tobacco free environment while ensuring the wellbeing of patients/clients who use tobacco products. Commits support to ensure the comfort of clients/patients who use tobacco, while they are receiving care in AHS facilities is essential. Provides for staff support through use of NRT products to manage cravings while at work 8

9 Tobacco Free Futures Development of a Linked System of Support across Continuum of Care 9

10 Development of an Evidence Based Model CAN-ADAPTT Guidelines for Smoking Cessation for Hospital Based Populations 1. All patients should be informed of smoke free policies. 2. Elective patients should be directed to resources to assist them to quit smoking prior to hospital admission or surgery where possible. CAN-ADAPTT. (2011). CAN-ADAPTT Canadian Smoking Cessation Guideline Version 2. Retrieved 02 28, 2011, from CAN-ADAPTT: 10

11 Development of an Evidence Based Model CAN-ADAPTT Guidelines for Smoking Cessation for Hospital Based Populations 3. All hospitals should have systems in place to: identify all smokers; manage nicotine withdrawal during hospitalization; promote attempts to long term cessation; and provide patients with follow-up support after discharge. 4. Pharmacotherapy should be considered to: manage nicotine withdrawal during hospitalization after discharge to promote long term cessation. CAN-ADAPTT. (2011). CAN-ADAPTT Canadian Smoking Cessation Guideline Version 2. Retrieved 02 28, 2011, from CAN-ADAPTT: 11

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13 Brief Intervention Model ASK Ask every patient about their tobacco use and pattern of use. Ask every patient about tobacco use in their home and vehicle. Document on patient chart. ADVISE Advise to quit with personalized message. Inform of the AHS Tobacco-Free Environments Policy. Document on patient chart. ASSESS Assess readiness to quit. Assess interest in pharmacotherapy support for withdrawal. Assess interest in behavioural support. Document on patient chart. ASSIST Assist with pharmacotherapy for withdrawal including ordering and monitor during stay. Link to behavioural support. Document on patient chart. ARRANGE Arrange further support by completing appropriate onsite and/or community linked referral(s). Arrange for continued pharmacotherapy on discharge. Document on patient chart. 13

14 10 Processes to Implementing the Tobacco Free Futures Model 1. Engage senior management & physician leadership 2. Form a multidisciplinary site steering committee 3. Complete pre-implementation assessments 4. Establish timelines for implementation 5. Review site documentation and staff roles 6. Determine pharmacotherapy practices for site 7. Establish standardized supplementary resources 8. Adopt a communication plan 9. Plan and schedule training for all staff 10.Evaluate & plan for sustainability 14

15 Tobaccofreefutures.ca 15

16 Brief Tobacco Intervention in Healthcare Settings 16

17 Thank you 17