Best Practices in Tobacco Treatment IDN 6.27.18
Objectives
Project SCUM was a plan proposed in 1995 by R. J. Reynolds Tobacco Company (RJR) to sell cigarettes to members of the "alternative lifestyle" areas of San Francisco, in particular the large number of gay people in the Castro and homeless people in the Tenderloin.
Physicians under-treat smokers AAMC-Legacy Survey: Physician Behavior and Practice Patterns Related to Smoking Cessation, 2007
Opportunity for providers Ending the Tobacco Problem: A Blueprint for the Nation. PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Brief Interventions are effective! PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Brief interventions PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Brief interventions PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Ask and Act
Since the implementation of a new electronic medical record (EPIC) in November referrals average 51 per month
Cheshire Tobacco Treatment Program: After a patient is referred: Patient scheduled for initial 45 minute assessment of tobacco use history Carbon monoxide screen done Plan created with patient if they are interested We provide discounts on patches, gum and lozenges We interface with providers to order prescriptions like inhalers, nasal sprays, Chantix or prescription NRT if needed Follow up appointment scheduled Patient may attend free monthly Tobacco-Free or Trying to Be Support Group Monadnock Family Services has started a tobacco treatment program which we are happy to support Visit documented in EMR
Pharmacotherapy
Pharmacotherapy PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
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First-line pharmacotherapy PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
First-line pharmacotherapy α β
Factors to consider when prescribing PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Bupropion SR Rx for Change Pharmacologic Product Guide
Nicotine gum Rx for Change Pharmacologic Product Guide
Nicotine inhaler Rx for Change Pharmacologic Product Guide
Nicotine nasal spray Rx for Change Pharmacologic Product Guide
Nicotine patch Rx for Change Pharmacologic Product Guide
Nicotine lozenge Rx for Change Pharmacologic Product Guide
Varenicline Rx for Change Pharmacologic Product Guide
Long term pharmacotherapy
Some patients have special needs.
Combining medications PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Counseling PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Deep Breathing(simulates smoking, relieves anxiety) Do Something Else Distraction Delay (for a minute, hour, day) Drink Water We offer comfort kits to patients with gum, lollipops, rubber band, straws or toothpicks, phone numbers which anyone can re-create)
Patients unwilling to quit Use brief intervention to promote motivation (motivational interviewing) Patients unwilling to quit may: Lack information about harmful effects or benefits of quitting Lack financial resources Have fears or concerns about quitting Think they can t quit PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Quit-lines
Medicare
Medicare
Medicare
Private Insurers
Medicaid NH Medicaid covers over the counter medications (with a prescription), Varenicline, Bupropion, nicotine inhaler and nasal spray. Prescription cannot be written for brand name. Must be written for Medicaid covered nrt. The Henry J. Kaiser Family Foundation. State Medicaid Program Coverage of Tobacco Dependence Treatments by Type of Coverage. 2009.
Summary of a few key recommendations
Key Recommendation PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Key Recommendation PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Key Recommendation PHS Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update
Power of intervention Partnership for Prevention. Preventive Care: A Profile on Use, Disparities, and Health Benefits: 2007.
Ask your patients if they use tobacco. Act to help them quit. kmcnally@cheshire-med.com 354-6513 http://quitworksnh.org/ 1-800-QuitNow
Questions?
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