Travis Wolff, PharmD. Growing Your Business with Smoking Cessation Services: Join the Quit Club 10/13/2016. Med-World Pharmacy, Sapulpa, Oklahoma

Transcription

1 Growing Your Business with Smoking Cessation Services: Join the Quit Club Travis Wolff, PharmD Ken Saunders, PharmD, TTS Jamie Mask, PharmD Shelley S. Hammond, MMC Travis Wolff, PharmD Med-World Pharmacy, Sapulpa, Oklahoma 1

2 Disclosure Travis Wolff is receiving an honorarium for this program. The conflict of interest has been resolved by peer review of presentation content. Learning Objectives Outline strategies to identify, attract and target patients for smoking cessation services. Discuss the role of a community pharmacist in helping patients set a quit date and stay on track. Describe structure and payment models for community pharmacy provided smoking cessation programs. 2

3 The Duck Walk Fly Swim The Pharmacist 3

4 Identify, Target, Attract Patients Current Patients AND Future Patients Current Patients Bag stuffers & in-store signage Referrals Staff Buy-In 4

5 Current Patients Dispensing data Nicotine replacement Buproprion or varenicline Breathing and airway medications Follow your nose Future Patients Outside signage Doctors offices, health department Hospital discharge 70% of smokers want to quit 5

6 Take ACTION Now! Write down one prescriber you plan to address this idea with at home Write down one place to advertise this outside the walls of your pharmacy How will you best gain your staff s support? Setting a Quit Date and Staying on Track New help line commercial Patients need to be ready Use the Seasons to help you 6

7 The 5 A s 1. Ask 2. Advise 3. Assess 4.Assist 5. Arrange ACCP Updates in Therapeutics 2016: Ambulatory Care Course 1. Ask Consider it a vital sign 2. Advise Clear, strong, and personalized 3. Assess Addiction level Readiness or belief they can quit ACCP Updates in Therapeutics 2016: Ambulatory Care Course 7

8 4. Assist Combination of drugs and counseling is more effective than either drugs or counseling alone 5. Arrange a follow-up contact Can take five years to quit for good 65% of self-quitters relapse during the first week 40% relapse after one year ACCP Updates in Therapeutics 2016: Ambulatory Care Course Motivational Interviewing for Patients Unwilling to Quit Express Empathy Develop Discrepancy Roll with Resistance Support Self-Efficacy U.S. Public Health Service. Treating Tobacco Use and Dependence 8

9 Take ACTION Now! Write down one place in your normal work routine you plan to ask patients about their smoking status. What season do you think would work best to start your own program? How will you respond when resistance to quitting is encountered? (important!) Describe Structure and Payment Models Structure: 12 week program 6 weeks class setting 6 weeks one-on-one Meet once per week in person with calls in between Support group environment can be helpful Be prepared: Emotions can run high! Written statements provide visual reminder 9

10 Payment Average margin on varenicline $23 Cmpd Nicotine Suckers 60-80% margin Flu & Pneumonia Vaccination 13 strain margin of $30-55 and up Will need the 23 strain one year later Corticosteroid/LABA or tiotropium average margin $29-58 Biggest Reward of All The impact you can have on a patient s life is the biggest reward of all. A NEW patient for life (huge profit) A friend for life 10

11 Take ACTION Now! Write down if you think a one-on-one or a group class would be more practical to implement your practice. How often do you plan to structure your contact with patients? How will you identify additional prescription and immunization needs of program participants? Tomorrow s Pharmacist Is A Different Kind of Animal 11

12 Bibliography Duck or Rabbit Illusion. Digital image. DMN3 blog. blog/you-need-a-quality-website-to-create-trust-in-visitors-minds. Web. 13 September Medication Therapy Management Visual Wheel. Digital image. Pharmacist APhA. Web. 13 September Uncle Sam I Want You. Digital image. Know your meme. Web. 13 September Cute Pink Elephant. Digital Image. 123rf. Web. 13 September Cute Snake. Digital image. Clipart Panda. Web. 13 September Moon, Jean. Pulmonary Disorders. In: Bainbridge JL, Cardone K, Cross LB, et al. Update in Therapeutics: Ambulatory Care Pharmacy Preparatory Review and Recertification Course, 2016 ed. Lenexa, KS: American College of Clinical Pharmacy, 2016: U.S. Public Health Service. Treating Tobacco Use and Dependence. Clinical Practice Guideline. U.S. Department of Health and Human Services Available at Accessed September 13, Cash Cow. Digital image. Jaskon Systems Blog. Web. 14 September Ken Saunders, PharmD, TTS CHI Health Lakeside Hospital Pharmacy, Omaha, Nebraska 12

13 Disclosure Ken Saunders is receiving an honorarium for this program. The conflict of interest has been resolved by peer review of presentation content. Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time. - Thomas A. Edison 13

14 The Real Reason Dinosaurs are Extinct The Problem Tobacco use is a chronic disease 21% of American men and 19% of American women smoke Smoking-related diseases claim 480,000 American lives each year Smoking costs the United States approximately $97.2 billion each year in health care costs and lost productivity Smoking is directly responsible for 87% of lung cancer cases and causes most cases of emphysema and chronic bronchitis 14

15 The Problem 22% of high school seniors smoke daily Male smokers incur $15,800 more lifetime medical expenses and 4 days lost from work per year Female smokers incur $17,500 more in lifetime medical expenses and 2 days lost from work per year Only 70% of family physicians currently ask their patients if they use tobacco Only 40% take further action. Return on Investment of a Tobacco Cessation program in place is $3250 / year / employee Multiple Role Influences of the Health on a Tobacco Care Team User Provider Family Faith Community Newspapers, Magazines TV, Radio Internet Co-workers Friends Community MD assisted quit rates at one year are 10-30% 15

16 Number of students trained 10/13/2016 National Estimates: Number of Students Trained Pharmacy Medicine Dentistry Nursing Total Academic year Not enough time Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates. The PHS Guideline (Strength of Evidence = A) 16

17 I can t help patients stop. Effective interventions exist: Pharmacotherapy Brief counseling Intensive counseling System changes Guideline available at Tobacco Use Results in a True Drug Dependence Tobacco dependence exhibits classic characteristics of drug dependence Nicotine: Nicotine is as addictive as heroin Causes physical dependence characterized by withdrawal symptoms upon cessation Smokers use tobacco to regulate their moods and emotions 17

18 Tobacco Dependence is a Chronic Disease Tobacco dependence requires ongoing rather than acute care Relapse is a component of the chronic nature of the nicotine dependence not an indication of personal failure by the patient or the clinician The 5 A s For Patients Willing To Quit ASK about tobacco use. ADVISE to quit. ASSESS willingness to make a quit attempt. ASSIST in quit attempt. ARRANGE for follow-up. 18

19 Why Ask? Ask every patient if he or she smokes Document as you would any other vital sign Flag files of smokers: Status apparent at subsequent visits Progress can be easily monitored Interactions exist between smoke/medicines Smoking is the leading preventable cause of death and disability in the world Tobacco use is either: Causing the illness you are treating Exacerbating symptoms Impeding healing Documentation I document using a progress note will help manage any QA reports with employers, medical directors, practice managers, third party payers Some sites may want to include vital signs, BMI, Blood pressure, pulse, while others may want to include a pain scale Progress notes are essential when services are reimbursed by a third-party payer. Audits do and will occur, especially with Medicare recipients 19

20 Tobacco Treatment Counseling Documentation Diagnosis Quit Line contacted Y N Session 1 Date Time in Time Physician out Total time Medications started: Notes: Signed: Date: Vitals Drug Allergies Diagnosis Quit Line contacted Y N Session 2 Date Time in Time Physician out Total time Medications started: Notes: Signed: Date: Vitals Diagnosis Quit Line contacted Y N Session 3 Date Time in Time Physician out Total time Medications started: Notes: Advise Even brief advice to quit results in greater quit rates Should be clear, strong, and personalized As your health care provider, I must tell you that the most important thing you can do to improve your health is to stop smoking. 20

21 Assess Willingness to Quit Are you willing to try to quit at this time? I can help you. Have you attempted to quit in the past? If so, how many times have you tried to quit? I have the training and tools that can help you quit. We can work together to accomplish this important goal. Assist Help set a quit date Provide practical counseling (alcohol, illicit drugs, other smokers in home) Past quit experiences Anticipate challenges and barriers Pharmacotherapy should be offered to all smokers trying to quit except where contraindicated Fiore

22 Arrange Bring everything together Provide carbon monoxide testing to illustrate the need to quit Help patient with third-party payers if needed Lobby third party payers if needed Show outcomes data to prove need / benefit / ROI Arrange Utilize other departments to assist Allow low-cost / no-cost follow up Be prepared for slips / relapse Arrange realistic therapy endpoints Follow up, Follow up, Follow up Any patient education encounter is a Medication Therapy Management opportunity 22

23 Other Tools Refer patient to other programs: Telephone Quit Line: QUIT - NOW Product cessation programs Local groups Hospital based interventions Web Site: Reimbursement Set up reimbursement depending upon course structure Patient pays cash Billing arrangements through employers Bill third party payers Medicaid with or without NRT s or medications Medicare with a collaborative physician agreement 2 cessation attempts per year including max 4 sessions, up to 8 sessions per 12 months Must wait 11 months from the 1 st of the 8 sessions Some Medicare Part D plans support medication payment Questions call (1-800-MEDICARE) 23

24 Reimbursement Sources and Marketing Your Practice Become a part of your state s Tobacco Free Program and website Set up reimbursement depending upon course structure Individual one-on-one counseling in a Clinic / Outpatient setting Group sessions weekend or 4 week, 6 week, 8 week courses Market to local service groups Kiwanis / Rotary / Veterans Market to local employers as part of a Wellness Program and Employee insurance premium decrease Market and contract with city, county, and state employees Perform CE programs for health care employees Factors to Consider When Choosing a Pharmacotherapy Patient preference Clinician familiarity with the medications Contraindications for selected patients Previous patient experiences with a specific agent (positive or negative) Patient characteristics (concern about weight gain, history of depression) Cost, Cost, Cost Remind patient that therapy is less expensive than tobacco Overcome patient reluctance to use medications Use medication assistance programs if needed 24

25 Treating Patients Not Ready to Make a Quit Attempt Relevance: Tailor advice and discussion to each patient Risks: Outline risks of continued smoking Rewards: Outline the benefits of quitting Roadblocks: Identify barriers to quitting Repetition: Reinforce the motivational message at every visit Quitlines QUIT-NOW callers are routed to a state-run quitline or the National Cancer Institute quitline. 25

26 Medication Therapy Management (MTM) Every tobacco patient encounter is an opportunity for MTM Review medications along with NRT s or other medications used to quit tobacco Report findings to physician Include therapy adjustment or change recommendations Monitor any inhaler use and reeducate proper administration Review and encourage cessation because of DM, COPD, HTN, anything Use carbon monoxide breathe analyzer to track success and compliance Approach anesthesiologists and surgeons on tobacco Cessation initiatives Medication Therapy Management Accept referrals for tobacco cessation and utilize MTM as a way to gain patient and physician trust and share provide outcomes data Add MTM to Tobacco Cessation contracts with groups and employers Consider MTM and a Medication Assistance Program (MAP) for the underinsured Report outcomes data for MTM and MAP programs to employers and prospective clients Since December 2007 through June 2016, my program has seen over 4100 patients and obtained over 4.85 million dollars worth of medications / cost savings due to MTM and MAP Emergency visits down by 70% for those that used ER as primary medication source Document, Document, Document 26

27 Training Information and Helpful Websites CDC University of Massachusetts ALA Rx for Change ACS Tobacco Free Nebraska /Pages/tfn.aspx Mayo Clinic Review of Tobacco Free Nebraska and Medicaid Reimbursement for Tobacco Cessation Counseling with Medications 27

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31 Reimbursement Sources and Marketing Your Practice Become a part of your state s Tobacco Free Program and website Set up reimbursement depending upon course structure Individual one-on-one counseling in a Clinic / Outpatient setting Group sessions weekend or 4 week, 6 week, 8 week courses Market to local service groups Kiwanis / Rotary / Veterans Market to local employers as part of a Wellness Program and Employee insurance premium decrease Market and Contract with City, County, and State employees Perform CE programs for health care employees 31

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33 There is Always the Exception Jamie Mask, PharmD, Creative Pharmacist, Brandon, Mississippi 33

34 Disclosure Jamie Mask is receiving an honorarium for this program. The conflict of interest has been resolved by peer review of presentation content. Shelley S. Hammond, MMC Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 34

35 Disclosure Shelley Hammond declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Panel Discussion 35

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