TRANSLATING SCIENCE INTO PRACTICE LSU Health Care Services Division

TRANSLATING SCIENCE INTO PRACTICE TRANSLATING SCIENCE INTO PRACTICE

LSU Health Care Services Division LSU Health Care Services Division Disease Management Program Quarterly MeetingDisease Management Program Quarterly Meeting

March 27,2007March 27,2007

Sarah Moody Thomas, PhDSarah Moody Thomas, PhD

Clinical LeadHCSD Tobacco Control Initiative

ProfessorLSU Health Sciences Center - School of Public Health

In collaboration withIn collaboration with

Michele Jean-Pierre Michele Jean-Pierre Ron Horswell Ron Horswell

Michael CelestinMichael Celestin Zhanying Zong Zhanying Zong

Danielle TrepagnierDanielle Trepagnier Kurt BraunKurt Braun

Krysten JonesKrysten Jones Jay BesseJay Besse

Monica LewisMonica Lewis Debbie Debbie HernandezHernandez

And…

• Debby Durapau Lucretia Young

• Tambria Hunt JoAnn Brooks

• D’Adario Conway Wendy Rhodes

• Elizabeth Sylvest Jennifer Miller

• Nakesha Auguster Betty Henry

Along with…

Members of the following:

• Tobacco Teams

• Process Redesign Team

• Research & Evaluation Team

• Health Care Effectiveness Team

• HCSD Administration

We We knowknow……

There is a body of evidence amassed from There is a body of evidence amassed from 40 years of accomplishments of tobacco 40 years of accomplishments of tobacco control:control: ResearchersResearchers AdvocatesAdvocates PractitionersPractitioners

We know…We know…

In Louisiana:In Louisiana:

• residents’ health status ranked 50residents’ health status ranked 50 th th in the nation*in the nation*• ~ 20% of population is uninsured~ 20% of population is uninsured• 1010thth highest smoking rate; ~ 23% smoke* highest smoking rate; ~ 23% smoke*• 1.5 Billion healthcare cost associated with 1.5 Billion healthcare cost associated with

tobacco usetobacco use• $663 million absorbed by Medicaid $663 million absorbed by Medicaid • Nearly 6500 adults die annually from smokingNearly 6500 adults die annually from smoking

United Health Foundation, 2006


• Efficacious treatments for tobacco use & Efficacious treatments for tobacco use & dependence exist.dependence exist.

• Cost- effective treatments for tobacco use Cost- effective treatments for tobacco use and dependence are key to preventing and dependence are key to preventing disease onset, progression and disease onset, progression and exacerbation. exacerbation.

• Clinical Practice Guidelines (CPG) are Clinical Practice Guidelines (CPG) are inadequately implemented. inadequately implemented.

Fiore, M. 2000Fiore, M. 2000


LSU Health Care Services Division LSU Health Care Services Division (HCSD):(HCSD):

• State’s largest and nationally the 5State’s largest and nationally the 5 th th largest largest integrated public healthcare system integrated public healthcare system – 1.5m outpatient visits, 1.5m outpatient visits, – 80,000 inpatient admissions80,000 inpatient admissions

• Well-established disease management program Well-established disease management program

• Administration committed to continuous quality Administration committed to continuous quality improvement and health systems researchimprovement and health systems research

We know …We know …

It is widely recommended that evidence-based It is widely recommended that evidence-based cessation services be integrated into cessation services be integrated into healthcare healthcare delivery systemsdelivery systems in order to obtain population- in order to obtain population-wide benefits.wide benefits.

– Robert Wood Johnson Foundation (1997; 2000) Robert Wood Johnson Foundation (1997; 2000) – US Department of Health and Human Services (2000)US Department of Health and Human Services (2000)– National Academy of Sciences, Institute of Medicine National Academy of Sciences, Institute of Medicine

(2001; 2003)(2001; 2003)– Centers for Disease Control and Prevention (2006)Centers for Disease Control and Prevention (2006)

PartnershipPartnership

2002 – HCSD started initiative to place treatment of tobacco use & 2002 – HCSD started initiative to place treatment of tobacco use & dependence at forefront of Louisiana’s public hospital systemdependence at forefront of Louisiana’s public hospital system

LSU HCSD Disease Management Program

Coordination ofresources acrossthe health caredelivery system toimprove disease outcomes

HCSD Disease Management Program

• Placed cessation services in a context:

– receptive to chronic care model; tobacco dependence could be viewed as such, requiring ongoing attention and treatment (Wagner, 1998)

– supportive of multi-component systems approach to improving the delivery and quality of health care

Goal: To increase adoption, reach and impact of evidence-based Goal: To increase adoption, reach and impact of evidence-based tobacco dependence treatmenttobacco dependence treatment

Push SciencePush Science Build CapacityBuild Capacity Boost DemandBoost Demand↔↔ ↔↔

↓ ↓↓ ↓↓ ↓↓

Translating Science into PracticeTranslating Science into Practice

Evidence based Evidence based treatment (CPGs)treatment (CPGs)

-Communicate for Communicate for wide populationswide populations

-Test/adapt in new Test/adapt in new populations and populations and settingssettings

-Research and Research and evaluate to improveevaluate to improve

Link systems– level Link systems– level tobacco supportstobacco supports

-IT to identify smokers, IT to identify smokers, prompt treatment prompt treatment

-Incorporate into broader Incorporate into broader quality assurancequality assurance

-Performance Performance measurement and measurement and reporting reporting

-Provider training and TAProvider training and TA

Policies and community Policies and community strategiesstrategies to increase to increase quitting and decrease usequitting and decrease use

-Bans, decreased cost, Bans, decreased cost, Quitline support, reflective Quitline support, reflective mediamedia

-Market programsMarket programs

-Redesign cessation services Redesign cessation services to increase appeal and useto increase appeal and use

Ultimate GoalUltimate Goal:: Reduce tobacco use &Reduce tobacco use &

health care burdenhealth care burden Orleans, CT. 2001; 2004 ; Isaacs, 2004

HCSD Tobacco Control Program

Design, implement and evaluate evidence-based cessation services in Louisiana’s public hospital system.


Push SciencePush Science

↓ ↓↓


Evidence based Evidence based treatment (CPGs)treatment (CPGs)

-Communicate for Communicate for wide populationswide populations

-Test/adapt in new Test/adapt in new populations and populations and settingssettings

-Research and Research and evaluate to improveevaluate to improve

2002 – 2004: Assessments conducted to determine prevalence of tobacco use, existing services and existing organizational infrastructure

Know Your Population – Patient SurveyKnow Your Population – Patient Survey

• Purpose Purpose – Characterize prevalence, patterns of tobacco Characterize prevalence, patterns of tobacco

use and readiness to quit among patients of use and readiness to quit among patients of this “safety net” health systemthis “safety net” health system

• MethodsMethods– Patients randomly selected within calendar Patients randomly selected within calendar

days days – Survey instrument administered face-to-face Survey instrument administered face-to-face

by trained interviewersby trained interviewers

Sample InformationSample Information

• N=777N=777• Predominantly:Predominantly:

• female (82%)female (82%)• African American (60%)African American (60%)• Poor (72% reported annual family incomes Poor (72% reported annual family incomes

< $15,000)< $15,000)• Ranged in age from 18 to 84 (mean= 49, Ranged in age from 18 to 84 (mean= 49,

s.d.=13.9)s.d.=13.9)• 25% current smokers25% current smokers

Readiness to Quit: % YesReadiness to Quit: % YesDuring the past 12 months, have you stopped During the past 12 months, have you stopped smoking for 1 day or longer because you were smoking for 1 day or longer because you were trying to quit?trying to quit? 49%49%

Are you planning to stop smoking within the Are you planning to stop smoking within the next 30 days?next 30 days? 23%23%

Are you seriously considering quitting within Are you seriously considering quitting within the next 6 months?the next 6 months? 56%56%

If we talk in a year, do you think you will be If we talk in a year, do you think you will be smoking?smoking? 41%41%

Are you aware of assistance that might be Are you aware of assistance that might be available to help you quit such as telephone quit available to help you quit such as telephone quit lines or local health clinic services?lines or local health clinic services? 24%24%

Treatment PreferencesTreatment PreferencesIf you were trying to quit smoking and cost If you were trying to quit smoking and cost was not an issue, would you use…was not an issue, would you use…

% yes% yes

Use a stop smoking product like nicotine patch Use a stop smoking product like nicotine patch or Zybanor Zyban

61%61%

Go to a stop smoking class or clinicGo to a stop smoking class or clinic 61%61%

Use self-help materials like books or videosUse self-help materials like books or videos 46%46%

Call a telephone quit lineCall a telephone quit line 38%38%

Use a product like acupuncture, hypnosis or Use a product like acupuncture, hypnosis or herbsherbs

35%35%

Get information from the internetGet information from the internet 24%24%

Experience with Healthcare Experience with Healthcare Delivery SystemDelivery System

Experience with health care professionals and tobacco Experience with health care professionals and tobacco cessation in past 12 monthscessation in past 12 months

% yes% yes

In the past 12 months, has a doctor, nurse or other In the past 12 months, has a doctor, nurse or other health care professional at this clinic advised you to health care professional at this clinic advised you to quit smoking?quit smoking?

73%73%

Did they also,Did they also,

Ask if you were willing to make an attempt to quit?Ask if you were willing to make an attempt to quit? 40%40%

Assist you in your quit attempt (offer counseling, refer Assist you in your quit attempt (offer counseling, refer for treatment or prescription to help?for treatment or prescription to help?

16%16%

Arrange follow up contact about your tobacco use?Arrange follow up contact about your tobacco use? 9%9%

Science PushScience Push: Lessons Learned: Lessons Learned

• Smoking rates higher than general population; similar to Medicaid population rates; varied by facility

• Pharmacologic and counseling were most preferred treatments

• It will be important to actively promote the availability of quit assistance

Baseline FacilityBaseline Facility SurveySurvey

• Purpose: Purpose: – Assess tobacco control practices and policiesAssess tobacco control practices and policies

• Distributed to all Louisiana public hospitalsDistributed to all Louisiana public hospitals– InpatientInpatient– OutpatientOutpatient– QAQA– AdministrationAdministration

• 32 surveys representing 10 of the hospitals were 32 surveys representing 10 of the hospitals were returnedreturned

Baseline Facility SurveyBaseline Facility Survey

• Comparison of findings– Survey instrument was developed based on Survey instrument was developed based on

McPhillips-Tangum’s* survey used with McPhillips-Tangum’s* survey used with Managed Care Organizations (MCOs)Managed Care Organizations (MCOs)

– Survey instruments were distributed and Survey instruments were distributed and completed during the Fall of 2003 through the completed during the Fall of 2003 through the Spring 2004Spring 2004

**McPhillips-Tangum, 1998. Results from the first annual survey on Addressing McPhillips-Tangum, 1998. Results from the first annual survey on Addressing Tobacco in Managed Care, TC Online.Tobacco in Managed Care, TC Online.

Implementation of the Guidelines: Implementation of the Guidelines: Comparison of HCSD and MCOsComparison of HCSD and MCOs

Barriers limiting provider’s effectiveness in addressing Barriers limiting provider’s effectiveness in addressing tobacco control with patients: Comparisontobacco control with patients: Comparison

Monitoring tobacco use: ComparisonMonitoring tobacco use: Comparison

Science Push: LessonsScience Push: Lessons LearnedLearned

• Tobacco cessation has to become a higher priority

• Cessation services should be meshed with existing processes of care

• Personnel designated solely to tobacco cessation needed to facilitate consistent service delivery

Follow up Site VisitsFollow up Site Visits

• Survey results presentedSurvey results presented

• Team building- recommendations for Team building- recommendations for Tobacco Team champions and membersTobacco Team champions and members

• Recommendations for process Recommendations for process implementationimplementation

Tobacco Control Initiative (TCI)

CPGs recommended system interventions shaped program development.

Provide: – Designated staff

• Certified cessation counselors

– Standardized processes, services and data collection

– Educational resources

– 5 As approach• Delineates roles and responsibilities of clinicians involved in the

support and delivery of cessation services

– Continuous program management and evaluation


Build CapacityBuild Capacity↔↔

↓

↓↓


Link systems– level Link systems– level tobacco supportstobacco supports

-IT to identify smokers, IT to identify smokers, prompt treatment prompt treatment

-Incorporate into broader Incorporate into broader quality assurancequality assurance

-Performance Performance measurement and measurement and reporting reporting

-Provider training and TAProvider training and TA



Push SciencePush Science

2003 – 2004: Process andprogram evaluation procedures and indicators determined

2004 - 2006: Phased Program implementation

Data Sources…Data Sources…

• Data collection and analyses are integral Data collection and analyses are integral components of health systems interventionscomponents of health systems interventions

• Identify eligible participants and manage day-to-Identify eligible participants and manage day-to-day activities day activities

• Evaluate the interventionEvaluate the intervention• Unobtrusive to participants, providers and staff Unobtrusive to participants, providers and staff • Detailed to determine the extent to which Detailed to determine the extent to which

program goals are metprogram goals are met

TCI Evaluation Components and Data TCI Evaluation Components and Data SourcesSources

Quantitative MeasuresQuantitative Measures__________________________________________________________________________________________________________________

Registry/Administrative DataRegistry/Administrative DataPopulation (DMED & Registry) Population (DMED & Registry) Users+ Not w/ check against DMEDUsers+ Not w/ check against DMEDRegistry Tobacco UsersRegistry Tobacco Users Rate of tobacco useRate of tobacco useRelapse Rate/New Use rateRelapse Rate/New Use rate Non users who became usersNon users who became usersQuit RateQuit Rate Users who became non usersUsers who became non users

Program (process/outcomes)Program (process/outcomes)Referral RateReferral Rate Rate of users referredRate of users referredRx assistance rateRx assistance rate Rate of referrals getting drug interventionRate of referrals getting drug interventionCounseling rateCounseling rate Rate of referrals getting ALA type interventionRate of referrals getting ALA type interventionQuit/Relapse RatesQuit/Relapse Rates Local data/registry mixLocal data/registry mix

Program (operations)Program (operations)FTEsFTEs FTEs funded by programFTEs funded by programFTE costFTE cost Funded FTE costs to the programFunded FTE costs to the programDrugsDrugs Program/non program drug costsProgram/non program drug costsHCSD in kindsHCSD in kinds Estimate of costs born by HCSDEstimate of costs born by HCSDnon HCSD in kindsnon HCSD in kinds Estimate of costs born by those external to program & Estimate of costs born by those external to program & HCSDHCSD

Qualitative/Programmatic InformationQualitative/Programmatic Information__________________________________________________________________________________________________________________Patient FlowsPatient Flows Graphical representations of programsGraphical representations of programsProgram Quarterly NarrativesProgram Quarterly Narratives Diaries of the programs from local perspectivesDiaries of the programs from local perspectivesAnnual evaluation team reportsAnnual evaluation team reports Visit reports of annual evaluation teams w/ Visit reports of annual evaluation teams w/

recommendationsrecommendationsAll of the above to be rolled up in annual reports and updated on monthly/quarterly/annual basis on a web site.All of the above to be rolled up in annual reports and updated on monthly/quarterly/annual basis on a web site.

Data Sources…Data Sources…

Tobacco RegistryTobacco Registry

CMEDCMEDDMEDDMED

*

Balancing Participant Identification, Program Balancing Participant Identification, Program Management and EvaluationManagement and Evaluation

Cessation Management & Evaluation DatabaseCessation Management & Evaluation DatabaseTrack program processes and identify opportunities Track program processes and identify opportunities

for process improvement projectsfor process improvement projects

Disease Management & Evaluation DatabaseDisease Management & Evaluation Database

Track patient encounter dataTrack patient encounter data

Electronic identification of tobacco users system-wideElectronic identification of tobacco users system-wide

Data Sources

• Weekly conference calls– Problem solving

• Data collection• Recruitment• Clinic interfacing

– Program development– Networking– Information sharing– Team building

TCI Cessation ServicesTCI Cessation Services

• Self-help materialSelf-help material

• Referral and facilitated access to state Referral and facilitated access to state Quit LineQuit Line– Proactive phone counselingProactive phone counseling

• Behavioral counseling Behavioral counseling – Group sessions Group sessions – Bedside interventionBedside intervention

• PharmacotherapyPharmacotherapy

Out Patient Process of CareTobacco User

Yes No

Patient Given:1. Self Help/Quit-line Referral Flyer2. Advice to quit by provider3. Medication Prescription

Patient Ready to quit in 30 days

Yes NoDo you want to be called by the Quit-

line?

Yes NoPatient information

given to TCI

Referral faxed to Quit-line by TCI

Referral to TCI

Contact in 30 days and 6 months

Mail out free NRT promotion bi-annually

Referral to TCI

Invite to Cessation Classes

Attended Class

Yes NoDoes the patient

have a medication prescription?

Does the patient have a medication

prescription?

Yes NoMedication

voucher given at 3rd class

Yes No

Pharmacotherapy

Pick up NRTs from Pharmacy

Refer to facility’s MAP office/TCI

Patient only wants medication

WellbutrinChantixOther

NRT

TCI StaffProvider

Cessation Classes

1st Class: MAP eligibility forms completed3rd Class: Medication voucher given

Out Patient Services

Patient Identification

Self help materials – quit line referral• Counseling

Group

PhoneCounseling + PharmacotherapyPharmacotherapy only• Motivational intervention

0 .1 .2 .3 .4 .5 .6Fraction of Patients Using Tobacco

all patients

HIV

DIABETES

CHF

ASTHMA

Tobacco Use LevelsAll Patients & by Disease Group

Smoking Rates by Quarter*Q1 2005 Q2 2005 Q3 2005 Q4 2005 Q1 2006 Q2 2006

Unique Patients 97225 111439 105289 81118 90047 89089

Smokers 23591 27715 27163 23045 25945 26293 % of unique patients 24% 25% 26% 28% 29% 30%

Referrals 964 1406 935 823 988 2190 % of smokers 4% 5% 3% 4% 4% 8%

Ready to quit in 30 days 637 952 654 558 725 1319 % of referrals 66% 68% 70% 68% 73% 60%

Contacted 165 479 574 539 703 1214 % of ready to quit 26% 50% 88% 97% 97% 92%

Scheduled for class 1 64 117 191 265 318 319 % of ready to quit 10% 12% 29% 47% 44% 24%

Attended 1+ classes 61 75 74 92 113 146 % of ready to quit 10% 8% 11% 16% 16% 11%

*8/10 facilities; DMED & CMED; Q1 = Jan-Mar

Smoking Rates by Disease Group, Longitudinally*

*8 of 10 facilities (D &C MED)

Q1 2005 Q2 2005 Q3 2005 Q4 2005 Q1 2006 Q2 2006DiabetesUnique Patients 17574 19700 18524 14913 16370 15723Smokers 3357 4144 4206 3856 4287 4141 % of unique patients 19% 21% 23% 26% 26% 26%

CHFUnique Patients 1450 1713 1566 1291 1386 1253Smokers 318 417 415 361 428 401 % of unique patients 22% 24% 27% 28% 31% 32%

asthmaUnique Patients 1101 1340 1254 1046 1146 947Smokers 211 290 274 262 273 217 % of unique patients 19% 22% 22% 25% 24% 23%

hivUnique Patients 3265 3528 3390 2255 2652 2703Smokers 1450 1716 1713 1164 1401 1451 % of unique patients 44% 49% 51% 52% 53% 54%

0

500

1000

1500

2000

2500

3000

3500

4000

q1-05 q2-05 q3-05 q4-05 q1-06 q2-06 q3-06

Number of Smokers ReferredAmong those Visiting Clinics

0

.02

.04

.06

.08

.1

.12

.14

.16

q1-05 q2-05 q3-05 q4-05 q1-06 q2-06 q3-06

Fraction of Smokers ReferredAmong those Visiting Clinics

Referrals Over Time

0100200300400500600

# R

ecei

ving

Pre

scrip

tions

600

800

1000

1200

1400

1600

#

Rec

eivi

ng S

elf-

Hel

p M

ater

ials

q1-05 q2-05 q3-05 q4-05 q1-06 q2-06 q3-06

Self-Help Materialsand Medication Prescriptions

0

5

10

15

20

25

30

35

Q1/2005 Q2/2005 Q3/2005 Q4/2005 Q1/2006 Q2/2006 Q3/2006 Q4/2006

Yearly Quarter

Per

centa

ge

Percentage of Smokers Referred that Received a Percentage of Smokers Referred that Received a Pharmacologic PrescriptionPharmacologic Prescription

Percentage of Each Pharmacologic Prescribed

0

20

40

60

80

100

120

Q1/2005 Q2/2005 Q3/2005 Q4/2005 Q1/2006 Q2/2006 Q3/2006 Q4/2006

Yearly Quarter

Per

cen

tag

e

Wellbutrin

Chantix

Other

40

60

80

100

120

140

160

180

200

q1-05 q2-05 q3-05 q4-05 q1-06 q2-06

Number of Referred SmokersAttending at least 1 Class

0

.02

.04

.06

.08

.1

.12

.14

.16

q1-05 q2-05 q3-05 q4-05 q1-06 q2-06

Fraction of Referred SmokersAttending at least 1 Class

Class Attendance among Referred Smokers

0.05.1.15

Fra

ctio

n Q

uitti

ng

.3

.4

.5

.6

.7

.8

.9

F

ract

ion

Qui

ttin

g o

r C

uttin

g B

ack

q1-05 q2-05 q3-05 q4-05 q1-06 q2-06QUARTER

Fraction Reporting Quitting or Cutting Backamong Class Attendees

Who Participates in Behavioral Counseling?

N= 986 class attendees; April 2005 - November 2006

• 62% Caucasian 36% African-American; • 69% Female• 46% smoke > 20 cigarettes/day• 68% have been smoking > 20 years• Appear more motivated to quit than overall HCSD smoking

population (e.g., 95% say they think they will quit within the next year)

Currently investigating:– What distinguishes class attendees from other smokers? – Among class attendees, what distinguishes between those who quit

smoking and those who do not?



↓ ↓↓ ↓↓ ↓↓


Policies and community Policies and community strategiesstrategies to increase to increase quitting and decrease usequitting and decrease use

-Bans, decreased cost, Bans, decreased cost, Quitline support, reflective Quitline support, reflective mediamedia

-Market programsMarket programs

-Redesign cessation services Redesign cessation services to increase appeal and useto increase appeal and use



Referral RatesReferral Rates

0

500

1000

1500

2000

2500

3000

Q1/2005 Q2/2005 Q3/2005 Q4/2005 Q1/2006 Q2/2006 Q3/2006 Q4/2006

Outpatient Referral Inpatient Referral

Access ServicesAccess ServicesIdentification of Current Users

“Have you used tobacco within the past 30 days?”

Tobacco Control InitiativeTobacco Control Initiative

Daily Census of In-patient Smokersprinted every morning in TCI Office

InterventionInterventionAssessment by Trained Tobacco

Cessation Counselor

Self-help MaterialSelf-help Material

Guide to Quit SmokingQuit-line pocket card

Behavioral CounselingBehavioral Counseling

Individual Session GivenGroup Session Appointment

Quit-line ReferralQuit-line Referral

Proactive Faxed ReferralPharmacotherapyPharmacotherapy

NRT & Non-NRT OptionAssistance Available

Cessation VideoCessation Video

Stages of Change DVD

AdviseAdvise

AssessAssess

AssistAssist

AskAsk

In-patient Process of CareIn-patient Process of Care

ArrangeArrange

Self-help material and quit linereferral in ALL admit packets

In Patient Process of CarePatient Admitted to

Facility

Tobacco User

Yes NoTCI Staff

Notified (at each facility)

TCI Staff Bedside Visit to Patient with Nurse Notification

Patient Consent for Bedside Consultation

Yes No

Patient Given:1. “Guide to Quit Smoking” with Verbal Explanation2. Quit-line Referral Card

Patient Given Care Options (See Option list)

Nurse Informed of: 1. Pharmacotherapy Recommendation 2. Post-Discharge Referral Option Chosen by Patient

Copy of Consultation Form Placed on Patient

Chart

Option List:1. Self Help Materials2. Bedside Consult/Counseling3. Quit-line Referral4. Smoking Cessation Classes (at each facility)5. Pharmacotherapy

Provider TCI Staff Self Help/Quit-line Referral Flyer in

All Admit Packets

TCI…TCI…

• A partnership of public, private and academic entities

• A multi-level systems approach to integrating evidence-based tobacco cessation services which include:– Self help materials– Quit line referral– Behavioral counseling (group /bedside)– Pharmacotherapy (free - low cost)

Goal: To increase adoption, reach and impact of evidence based Goal: To increase adoption, reach and impact of evidence based tobacco dependence treatmenttobacco dependence treatment


↓↓ ↓↓ ↓↓



health care burdenhealth care burden

Orleans, CT, 2001, 2004; Isaacs, SL, 2004

↓↓ ↓↓ ↓↓

Future DirectionsFuture Directions

• Refine data sources• Expand services to special populations (i.e.

pregnant women, patients with chronic illnesses)• Examine strategies to provide treatment with

patients not interfaced with TCI (e.g. NRT distribution)

• Expand cessation resources on HCSD website– Provider CME– Tool kits for implementing policies for smoke-free

campus

• Redesign processes to increase appeal and use of cessation services

CLIQCLIQ

5 A’s …5 A’s …

• The Five A’s strategyThe Five A’s strategy– Ask, Advise, Assess, Assist, ArrangeAsk, Advise, Assess, Assist, Arrange

• But, if you are too busy for all five, how But, if you are too busy for all five, how about just two?about just two?– Ask your patients about tobacco useAsk your patients about tobacco use– Advise about quittingAdvise about quitting

Quit Line Use In Tobacco Cessation

• Easy to promote

• Another option for smokers

• Available to anyone with a telephone

• Reduces barriers (i.e. transportation, job)

• Increases quit attempts

• Works with diverse populations

• It’s a minimum intervention for providersAdapted from the Smoking Cessation Leadership Center

The Quit Line and HCSD PatientsThe Quit Line and HCSD Patients

• Approximately 27 thousand HCSD patients use Approximately 27 thousand HCSD patients use tobaccotobacco– Roughly 20 thousand of these patients say they want to Roughly 20 thousand of these patients say they want to

quitquit

• Implementing the quit-line could quadruple the Implementing the quit-line could quadruple the average cessation rate, translating to roughly average cessation rate, translating to roughly 3,000 quitters 3,000 quitters

• Adding brief behavioral counseling and medication Adding brief behavioral counseling and medication can increase the average cessation rate six fold, can increase the average cessation rate six fold, translating to roughly 4,400 quitterstranslating to roughly 4,400 quitters

Adapted from the Smoking Cessation Leadership Center


• Tobacco cessation is the single most Tobacco cessation is the single most effective step to lengthen and improve effective step to lengthen and improve patients’ livespatients’ lives

• Tobacco cessation has immediate and Tobacco cessation has immediate and long-term benefits and is well worth the long-term benefits and is well worth the effort, both for patient and clinicianseffort, both for patient and clinicians

• Helping patients make a quit attempt is Helping patients make a quit attempt is less time consuming than you thinkless time consuming than you think

• Many new tools exist to help patients quitMany new tools exist to help patients quit

“Knowing is not enough; we must apply. Willing is not enough; we must do.”

-Johann Wolfgang von Goethe

Documents

TRANSLATING SCIENCE INTO PRACTICE LSU Health Care Services Division