A New Standard of Care: Smoking Cessation Re-engagement Presentation by: Dr. Colleen Webster & Vince Martin, M.S.W.

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1 Kingston Family Health Team A New Standard of Care: Smoking Cessation Re-engagement Presentation by: Dr. Colleen Webster & Vince Martin, M.S.W. Participating Family Health Teams Kingston Family Health Team Petawawa Centennial Family Health Team Upper Canada Family Health Team Lower Outaouais Family Health Team Ottawa Valley Family Health Team

2 Kingston Family Health Team Smoking Cessation Re-engagement Roll Out Background A pilot project was conducted in 2014 by the Kingston Family Health Team (FHT), which was very successful. The purpose of the project was to re-engage relapsed smokers and to gather data from successful quitters to incorporate in the smoking cessation program. In 2015, the project was rolled out to all the patients in the Kingston FHT and 4 other FHTs in eastern Ontario: Petawawa Centennial Family Health Team, Upper Canada Family Health Team, Lower Outaouais Family Health Team and the Ottawa Valley Family Health Team. Pfizer provided funding assistance for the members of the Smoking Cessation Programs at the FHTs to conduct an after hours phone survey of the patients who had attended a Quit Plan visit 6 months or longer prior to time of the project. Survey Monkey.com was utilized to design a set of 6 questions.

3 Survey Questions 1. Patient ID and Gender. 2. What was the single most important factor in your decision to make a quit attempt? 3. Did you feel more confident in your quit attempt as a result of the follow-up? 4. Have you smoked/used any form of tobacco since your quit attempt? 5. Which of the following do you feel was the primary reason for your relapse(s)? [1. Stress 2. Cravings 3. Boredom 4. Weight gain 5. Other:] 6. Do you want to make another quit attempt in the next 3 months? 7. (If still smoke free) Which of the following do you feel has been most helpful in your success to stay tobacco free? [1. Family 2. Health 3. Feeling better 4. Other:] 8. Patient closing remarks/comments. Survey Results Kingston Petawawa Centennial Upper Canada Lower Outaouais Ottawa Valley All Sites Total Eligible Patients Total Reached 305 (50%) 56 (47%) 110 (43%) 133 (61%) 173 (74%) 777 (55%) Declined Survey 22 (7%) 3 (5%) 24 (22%) 5 (4%) 7 (4%) 61 (8%) Completed Survey 283 (93%) 53 (95%) 84 (76%) 128 (96%) 166 (96%) 716 (92%) Still Smoke Free 82 (29%) 17 (32%) 28 (33%) 38 (30%) 45 (27%) 210 (29%) Relapsed 201 (71%) 36 (68%) 58 (69%) 90 (70%) 121 (73%) 506 (71%) Re-engaged 82 (41%) 10 (28%) 16 (28%) 37 (41%) 55 (45%) 200 (40%)

A New Standard Of Care: Smoking Cessation Re-engagement Presentation by: Dr. Colleen Webster & Vince Martin, M.S.W. Purpose To reengage relapsed smokers.

4 A New Standard Of Care: Smoking Cessation Re-engagement Presentation by: Dr. Colleen Webster & Vince Martin, M.S.W. Purpose To reengage relapsed smokers. Determine the factors that helped the patients who are still smoke free, for incorporation into the smoking cessation program. Ensure applicability and usefulness of re-engagement efforts across a wider range of Teams. Method Pfizer provided funding assistance for the members of the Smoking Cessation Programs at five Family Health Teams (FHTs) to conduct an after-hours phone survey of the patients who had attended a Quit Plan visit at least six months or longer prior to the survey. Survey Monkey.com was utilized to design a set of 6 questions. Kingston Participating FHTs (93%) Re-engagement Success! 716 surveys completed Lower Outaouais Ottawa Valley Petawawa Centennial Upper Canada (96%) (96%) (95%) (76%) Patients contacted Completed Survey 40% 29% 71% Still smoke free (210) Re-lapsed (506) Re-engaged (200)

5 RE - ENGAGEMENT - Methodology at KFHT by Vince Martin Relapsed patients who had tried to quit through the OMSC process and who had relapsed back to smoking were offered immediate scheduling for another Quit Plan or MORE DETAILED HELP. DETAILED HELP ( topics are Psychological and Behavioral ): Why relapse occurs; processing mental scripts and self talk; lessons learned from slip event. Expanded and improved Quit Plans; 9 emotional reasons homework; test and train alternatives. Quit Day ( an event ); quitting also as a life journey; calculating your addiction strength. The nature of physical withdrawal; how medications help; mental / emotional habituation. The cult; smoking identity; intense valuing; URGES and CRAVINGS; the need to reprogram.

6 Thinking Ahead - plans for future development at Kingston Family Health Team - Vince Martin We hope to expand the ways, means, formats and the content of DETAILED HELP by: Offering an on line package (slides and voice) through our website which will be available to all our patients. Expanding the information included online to cover ALL the issues patients identified as causes of relapse including: 1 st stress; 2 nd - eating and weight gain; 3 rd - medication challenges; 4 th - cravings and urges. We hope to have other community partners (hospitals, FHTs, and public health) involved with us.

Expert Task Group Recommendations

Expert Task Group Recommendations CASE FOR ACTION 157,000 Champlain residents smoke daily. Tobacco use will kill half of these residents if they do not quit. Tobacco use is a very powerful modifiable CVD