Helping Patients to Quit Using Tobacco Hill Air Force Base Dental Clinic August 11, 2005 Isa Kaluhikaua, CHES Davis County Health Department Bureau of Health Promotion 451-3398 firstname.lastname@example.org
Why are we here? • Train dental clinicians in a proven effective 3-minute intervention to help their tobacco using patients to quit. • Provide consistent tobacco cessation information to all tobacco using patients. • Introduce The TRUTH Network materials. • Address ADHA and UDHA goals.
Why is this my job? • More than half of adult smokers see a dentist each year. • Effects of tobacco use are visible in the mouth even in relatively early stages of use. • Tobacco is the root of many oral health problems. • Dental patients request treatments that counter the effects of tobacco use on their appearance. • Most dental patients want and expect dental professionals to provide cessation advice. • Brief tobacco dependence treatment is effective, and every patient who uses tobacco should be offered at least brief treatment.
Tobacco Use Trends in Utah Average age of initiation - 12.5 60% by age 14 90% by age 19 Tobacco use rate in Davis County 9.8% Tobacco use rate at HAFB 28%. There are more than 190,000 smokers in Utah. 81.5% of Utah smokers report that they would like to quit.
Tooth-loss, jawbone loss and periodontal diseases. Impeded effectiveness of periodontal therapy, dental implants, and wound healing. Tooth decay for the tobacco-user’s children, results from exposure to secondhand smoke 4x the risk of developing oral cavity or oropharyngeal cancer, which kills 49% of its victims within 5 years of diagnosis. Oral Health Problems caused by Tobacco
Success Rates of Tobacco Dependence Treatments • No help = 7-8% • Health care provider advice (<5 minutes) = 10-12%, 15% for pregnant women • Counseling (91-300 minutes) = 10-20% • NRT = 15-30% • NRT + Counseling (91-300 minutes) = 25-35% • Zyban = 25-35%
How do I help tobacco users quit? Even a minimal intervention, lasting less than 3 minutes, can significantly increase overall tobacco abstinence rates. The “5 A’s” • ASK the patient if he or she uses tobacco • ADVISE him or her to quit • ASSESS willingness to make a quit attempt • ASSISThim or her in making a quit attempt • ARRANGEfor follow-up
How do I help tobacco users quit? cont. Use The TRUTH Network materials to help you with your 5A’s intervention. • Treating Nicotine Dependence, Utah’s Healthcare Provider Guide • Brochures (Welcome Guide & Think About It) • Utah Quit Line & Utah QuitNet • Fax Referral Form • Pharmacotherapy Guide
1. ASK Ask EVERY patient about tobacco use status at EVERY visit. • Current • Former • Never This occurs most consistently when there are systems in place, such as question on intake form, chart stickers, or electronic prompts on electronic medical records. Chart stickers are available.
2. ADVISE Clinicians should urge all tobacco users to quit. Even brief advice to quit by a clinician results in greater quit rates. Smokers cite a clinician's advice to quit as an important motivator for attempting to stop smoking. Advice should be: • clear • strong • personalized Specific to the individual 's own situation (e.g. oral health condition, family status, costs of tobacco).
ADVISE cont. Nicotine Stomatitis “Smoker’s Palate” Black, hairy tongue Gingival recession Gingivitis Periodontitis, Stained teeth Leukoplakia Oral Cancer “I can’t see what tobacco is doing to your heart, lungs, brain and other organs, but I would like to show you some changes in your mouth.”
3. ASSESS "Are you willing to try to quit at this time?"
What if they are not willing? • Provide patient with “Think About It” brochure from The TRUTH Network.
4. ASSIST • Provide patient with “Welcome Guide” brochure from The TRUTH Network. • Discuss the quitting process. • Set a quit date. • Tell family and friends. • Review past quit attempt experiences. • Anticipate challenges. • Remove tobacco products. • Avoid alcohol. • Recommend pharmacotherapy.
Pharmacotherapy • Use the Pharmacotherapy Guide from The TRUTH Network. • Many medications have been approved by the FDA for smoking cessation and have been shown to significantly improve abstinence rates. • They work to reduce cravings and other withdrawal symptoms.
ASSIST cont. “Would you like the Utah Tobacco Quit Line to help you quit?”
ASSIST cont. YES Have patient fill out the Utah Tobacco Quit Line Fax Referral Form. 1. Clinician writes name on item 1 of the form. 2. Patient fills out items 2-12. 3. The client must sign the form.
ASSIST cont. • NO • If the patient does not want to fill out the form, give the patient the Quit Line's toll free telephone number (1-888-567-TRUTH) or offer a Utah Tobacco Quit Line card so that the patient can contact the Quit Line when they are ready.
UTAH TOBACCO QUIT LINE1-888-567-TRUTH (8788) • The Quit Line triple or quadruples quitting rates of Utah tobacco users. • Free Cessation Services: • Telephone Counseling • Quit Kits • Referrals • Nicotine Replacement Therapy (NRT) if eligible and appropriate
UTAH QUITNEThttp://utahquitnet.com All Utah QuitNet services are available to all Utahns free of charge. • Personalized quitting plans • Quitting information • Peer support • Expert advice • Pharmaceutical product support
5. ARRANGE FOLLOW-UP Fax the form to the Utah Tobacco Quit Line's toll free fax number: 1-800-483-3114 The Utah Tobacco Quit Line faxes your clinic so that you know what type of services your patients received.
Review • Ask • Advise • Assess • Assist • Provide “Welcome Guide” brochure & Fax Referral Form • Brief discussion of quitting process • Pharmacotherapy • Arrange follow-up • Fax referral form to Utah Tobacco Quit Line
American Dental Hygienists’ Association’s Smoking Cessation Initiative Goal: 50% of dental hygienists screen their clients regarding tobacco use by 2006 www.askadviserefer.org
Utah Dental Hygientists’ AssociationGold Card Program Goal: One referral to Utah Tobacco Quit Line for each hygienist.
Tobacco Cessation Websites for Health Care Providers 1. Tobacco Cessation Guideline Publications: http://www.surgeongeneral.gov/tobacco/default.htm • Dr. Fiore's course in the 5 A's:http://www.cme.wisc.edu/online/ctri/index.htm • Utah Department of Health, Tobacco Prevention & Control Program http://www.tobaccofreeutah.org/healthcare.html