Engaging Other Health Care Providers in Multidisciplinary Approaches to Cessation

1. Engaging Other Health Care Providers in Multidisciplinary Approaches to Cessation The Smoking Cessation Leadership Center and Its Partners NCTOH October, 2007

2. The Center • Program office RWJF • Additional funding from VA, American Legacy Foundation • Begun in 2003 • Housed at UCSF • Social Marketers • Provide technical assistance, small grants

3. SCLC Mission • Fewer people smoke, more people quit, and more health professionals helping them do it.

4. We Work Through Partnerships • We only work with groups that share our mission • We provide technical assistance and small grants • We start where they are, set targets together, and develop work plans • We measure impact

5. What We Do NOT Want • 17-year lag from research to practice • According to article Managing Clinical Knowledge for Health Care Improvement -“The words of scientists should be presented in ways that are more helpful to those who must translate them into action. • Focus on ourselves as a funder rather a focus on results

6. Major Strategies of SCLC • Widen circle of health professionals who advocate cessation • Expand menu of cessation strategies • Make cessation intervention simpler, more concrete and easier to do • Clinical Practice Guidelines-5As and Other ways • Ask Advise Refer • Ask and Act • Leverage cessation strategies thru social marketing efforts

7. 1 800 QUIT NOW • Callers are routed to state quitline or the National Cancer Institute quitline. • Double a smokers chance of quitting • Easy, brief and effective intervention • Direct counseling • Central resource for materials, information and referrals – triage callers. • Multi-language, culturally tailored services • Trained staff

8. Health Professionals • Dental Hygienists • Nurses • Pharmacists • Family Physicians • Physician Assistants • Emergency Physicians • Anesthesiologists • Diabetes Educators • Mental Health Professionals

9. Hospitals JCAHO Health systems – VA, Kaiser Permanente, Northern California State Mental Health Program Directors Business – Make It Your Business, Step Up! Labor Institutions Organizations Other Avenues • Marketing Channels/Tools • Place Based Approaches

10. Marketing Channels • Quit Now Card • Rx for Change • Pocket Guide • Mental Health Facility and Provider Toolkits

11. The Blue Card

12. Rationale for The Card • Promotes the model Ask-Advise-Refer in a simple, concrete way • Conveys simplicity and “do-ability” of cessation intervention • Can be kept in wallet or purse until smoker is ready to use it • Inexpensive (11 cents each) • Small but powerful

13. To Brand or Not to Brand • We deliberately chose not to brand • We encourage others to do so • Some have, such as ADHA and Wrigley, some hospitals • Most choose not to

14. Quit Now Card Facts • 3 million cards are currently in distribution • Majority of cards are used by Physicians and Clinicians • New interest from MH professionals

15. Who Buys the Cards? • Companies like Wrigley, Pfizer, Glaxo, Wellpoint • Private, nonprofit, and government organizations • State tobacco control programs • Associations • VA • Universities • Health Professionals • Substance abuse treatment clinics • Hospitals, human resource managers, tobacco control directors, clinician groups • Individual medical and dental practices

16. Rx for Change

17. Rx for Change – ripple effect

18. Pocket guide

19. Mental HealthFacilities and Provider toolkits

20. Los Angeles • Help 200,000 (out of a million) smokers quit over 3 years (2010 goal)

21. Primary Measure • Reduce 19.1% adult prevalence to 14% by year 2010 • Reduce 21.7% teen prevalence to 16% by year 2010 • Increase Quit attempts from 60% to 80% by year 2010 • Secondary Measure • Double call utilization of quitlines (currently at 0.50%) each year for next three years

22. What is next? • “Smokeless in Seattle” • Spanish Language Card • Mental Health and • Substance Abuse

23. For more information visit http://smokingcessationleadership.ucsf.edu

24. Tobacco Free Nurses Linda Sarna RN, DNSc, FAAN Stella Aguinaga Bialous, RN, MScN, DrPH Marjorie Wells, RN, PhD 2007 National Conference on Tobacco or Health, Minneapolis, MN October 24 - 26, 2007

25. Barriers to nurses’ involvement in tobacco control • Lack of education & skills • Continued smoking among professionals • Lack of adequate nursing leadership Supported by the Robert Wood Johnson Foundation Smoking Cessation Leadership Center

26. Tobacco Free Nurses’ Mission 1) Support and assist smoking cessation efforts of nurses and nursing students; 2) Provide tobacco control resources for use in patient care; 3) Enhance the culture of nurses as leaders and advocates of a smokefree society If the 2.2 million working nurses in the U.S. each helped one person a year quit smoking, nurses would triple the U.S. quit rate.

27. Tobacco Free Nurses: first national initiative in the USto provide support with tobacco cessation and establish a framework for engaging nurses in tobacco control

28. Tobacco Free Nurses Initiative • - Online cessation program • Media • Website • Leadership building

29. Why a Nurse-focused resource? • Multiple sources of information – too many? • No need to reinvent the wheel… www.tobaccofreenurses.org

30. Award-winning website(www.tobaccofreenurses.org) • Enhances access to tobacco control resources • Ongoing listing of all articles on nursing and tobacco in the peer-reviewed literature. • First on Google search for nurses and tobacco, receives an average 16,000 hits/month; > 55,000 unique visitors

31. TFN’s Partnerships • Professional nursing organizations • ANA/ANF • NCEMNA • Many specialty organizations • Nursing educational organizations • AACN • N-OADN • NFLPN • Smoking Cessation Leadership Center • Government agencies • AHRQ • Commission on Accreditation of Healthcare Organizations (JCAHO)

32. Evaluation of Awareness of TFNSurvey of > 3500 Nurses in Magnet healthcare organizations • Nurses familiar with TFN were significantly more likely to: • Ask patients about tobacco use • Advise them to quit smoking • Assess readiness to quit • Assist in quit attempts • Arrange for follow-up • Recommend cessation medications, • Refer to telephone quitlines and other resources

33. Other Measures of Impact • Reached > 2 million nurses through paid & in-kind ads in nursing journals/newsletters • Reached > 500,000 nurses • 1st National conference on nursing research and cessation -- proceedings published in Nursing Research(July 2006) • 1st Nursing leadership conference focused on leading nursing organizations to promote tobacco control • Engaged >5,000 nurses through presentations at professional meetings • Published 13 data-based and translational articles on nurses’ role in tobacco control and guest edited two journal supplements on nurses and tobacco

34. Collaboration with Educators First-ever national effort to engage new health care professional students in tobacco control • >500,000 student nursing students sent letters • American Association of Colleges of Nursing (AACN): 620 BSN schools (approximately 240,000 students/year) in 2006 & 2007 • National Organization of Associate Degree Nursing (N-OADN): 950 schools (approximately 10,000 students/year) 2006 & 2007 • National Federation of Licensed Practical Nurses, Inc. (NFLPN) 1188 LPN programs (approximately 11880 students/year) 2007

35. Collaboration with QuitNet® • Support of nurses in their quit efforts through Nurses QuitNet® • > 2,200 nurses registered for quitting services • Average 500,000 page views/year • 80,000 page views/year by non-registered visitors

37. Collaboration with Other AgenciesAgency for Healthcare Research & Quality Pocket guide: Ask, Advise, Assess, Assist, & Arrange • Listing of smoking cessation medications approved by the U.S. FDA (updated) • National Quitline 1-800-QUIT NOW

38. AHRQ - TFN Partnership To reduce barriers to nursing involvement to tobacco control • The Helping Smokers Quit: A Guide for Nurses • > 180,000 have been printed since it’s debut in 2005 • Continues to be the most requested cessation product at AHRQ • Many groups have reproduced the pocket guide • ANA printed 25,000 in 2006 • Veteran’s Administration (VA) reproduced 20,000 of the pocket guides in 2006 directed at all clinicians

39. Expectations for nursing involvement in cessation interventions • JCAHO indicators include smoking cessation interventions provided to patients with diagnoses of acute myocardial infarction, heart failure and pneumonia.

40. Jerod Loeb, PhDExecutive Director for the Joint Commission “While effective systems and processes help hospitals improve their performance in providing smoking cessation counseling to patients, the greatest difference between high- and low-performing hospitals is the presence of a dedicated nurse champion” AHRQ Press Release, 2005

41. Future Directions • Maintain & enhance the established website to support nurses in their tobacco control efforts • Continue to create and disseminate nurse-friendly tobacco control resource materials • Rx for Change curriculum for nurses • Continue outreach to nurse leaders • Ensure that helping smokers quit is a standard of quality nursing care • Support transition to smoke free healthcare campuses

42. For more information visit http://www.tobaccofreenurses.org/

43. American Dental Hygienists’ AssociationSmoking Cessation Initiative (SCI) Tobacco or Health Conference 2007

44. History of the SCI • 14 member task force met September 2003 • Summit sponsored by the RWJF SCLC • Grant awarded in November 2003 • A nationwide campaign designed to promote smoking cessation intervention by dental hygienists "The advice of a dental hygienist can be a major motivation for a quit attempt by a patient who smokes.“ -- Tammi O. Byrd, RDH, ADHA President 2003-2004

45. The Objective • Baseline and Target: • Increase to 50 the percentage of dental hygienists that screen their clients regarding tobacco use (rate, type and amount) by 2006. • Baseline 25% in 2001 Journal of Dental Hygiene study (Winter 2001)

46. Main Elements of the SCIYear One Educational Program: Ask. Advise. Refer SCI Liaison Program: Designate a liaison in each state Dedicated Website: www.askadviserefer.org

47. SCI Year Two • Grant renewed November, 2004 • SCI Project Manager, January, 2005 • SCI Administrative Assistant • SCI Liaisons in-state support • Six state presentations • Quitnow card distribution

48. SCI Year Three • Grant renewed November, 2005 • SCI Project Consultant • SCI Administrative Assistant • SCI Liaison education support • Twelve district presentations • On-line liaison survey ASK. ADVISE. REFER. – ADHA’s Smoking Cessation Initiative

49. SCI Year Four • Grant renewed November, 2006 • Webcasts • National survey results • Complete district presentations • ADHA Tobacco Cessation Forum • Presentations per request ASK. ADVISE. REFER. – ADHA’s Smoking Cessation Initiative

50. National Survey Results • 56% of dental hygienists offer cessation treatment at every or most visits • 71% intervene with “higher risk clients” • 78% of those respondents who had accessed the AAR website had incorporated cessation information into practice ASK. ADVISE. REFER. – ADHA’s Smoking Cessation Initiative