With Support From

1. Where There’s Smoke….WE CAN BE THE DIFFERENCELocal Health Agencies: Health Care Provider Toolkits February 26, 200812:00 pm – 1:00 pm MTGoToMeeting: https://www1.gotomeeting.com/register/230647349Call-in#: 888-847-3448 passcode: 572554#If you have technical difficulties, please call (720) 297-1681 for assistance. With Support From Presented by:Elizabeth Kraft, MD MHS Michele Patarino, MBA/MSHA Alison Long, MPH

2. Objectives • Brief overview of CCGC • LHA Checklist • CCGC Resources: • Provider toolkits • Website • Webinars • TRIA recruitment www.coloradoguidelines.org/tobacco 2

3. Colorado Clinical Guidelines Collaborative (CCGC) A coalition of health plans, physicians, hospitals, employers and other entities working together to implement systems and use evidence-based guidelines to improve healthcarein Colorado. • Clinical Guidelines: • Diabetes • Depression • Screening for Colorectal Cancer • Asthma • Pediatric and Adult Immunizations • Upper Respiratory Infections • Gestational Diabetes • Obesity • CV/Stroke • Tobacco Cessation and Secondhand • Smoke Exposure www.coloradoguidelines.org 720/297-1681 www.coloradoguidelines.org/tobacco 3

4. CCGC Tobacco Team • Michele Patarino, MBA MSHA • Alison Long, MPH • Emily Gingerich • Emma Goforth • Elizabeth “Cissy” Kraft, MD MSH www.coloradoguidelines.org/tobacco tobaccoinfo@coloradoguidelines.org 720/297-1681 www.coloradoguidelines.org/tobacco 4

5. CCGC & LHA Working Together to Reach More Providers • Reaching more providers with tools to assist in practice redesign = Changing provider behavior so more will follow the tobacco guideline. • More providers following the clinical guideline will lead to more patient quit attempts with appropriate support • More quit attempts with appropriate support will lead to more successful quitters www.coloradoguidelines.org/tobacco 5

6. Changes in the Healthcare Environment: Motivating Providers about Tobacco Cessation Efforts Performance measures and public reporting “Pay for performance” Relatively “easy” guideline to implement High quality of QuitLine services Saving lives www.coloradoguidelines.org/tobacco 6

7. Integrate Tobacco Cessation into YOUR Office: Tobacco Rapid Improvement Activity (TRIA) • FREE • Use the tobacco cessation/SHS guideline: 2A/1R • Lunch session with entire office staff: “TRIA” exercise • Why tobacco cessation is important for your office • Brainstorm implementation goals for each team staff member • Make changes after each patient (Tobacco) Rapid Improvement Activity:Integrating Tobacco Cessation into Your Clinical PracticeYou Can Be the Difference! 7

8. LHA/Healthcare Provider Checklist • Identify primary care physician practices (including pediatricians) in your area. Also identify mental health practices (University of Colorado staff has already contacted Mental Health Centers). • Stop in the practice and introduce yourself to the Office Manager • Note: avoid Mondays and Fridays if possible • Right after lunch is generally a good time for a visit or call • Ask if the Office Manager is the best point of contact, or if one of the clinicians is particularly passionate about preventive care in general or tobacco cessation specifically practices • Provide information on QuitLine, w.STEPPitems.com, and local resources (cessation classes, etc.) www.coloradoguidelines.org/tobacco 8

9. LHA/Healthcare Provider Checklist • If the Office Manager (or other contact) is receptive, show the provider tool kits • Ask if they think they can commit to using some of the materials before you give the tool kits away. If they say “no,” then take them with you and leave your card. If they say “yes,” leave the tool kits. • If you leave the tool kits, tell the contact that you will phone back in a week to see if they were useful and if there is additional support that they might need.) • Come or call back in a week and inquire if they found the tool kit useful, and if they would like additional training and support. If yes, refer to CCGC. www.coloradoguidelines.org/tobacco 9

10. LHA/Healthcare Provider Checklist • If the practice goes through CCGC training (TRIA),e-mail tobaccoinfo@coloradoguidelines.org one week after the TRIA and ask for a copy of the practice’s action plan. • CCGC will phone or e-mail to confirm their plans. You may also visit the practice during the six weeks after the training and ask if they have obtained needed materials, or have any questions, issues. If you visit, please notify CCGC at tobaccoinfo@coloradoguidelines.org. • If your LHA is willing and able to do more in-depth provider interventions, please contact CCGC and we will arrange for individual collaborative planning. www.coloradoguidelines.org/tobacco 10

11. Tobacco Toolkits www.steppitems.com www.coloradoguidelines.org/tobacco 11

12. Tobacco Cessation Toolkit www.coloradoguidelines.org/tobacco 12

13. Tobacco Cessation Toolkit • -Cover letter • -Tobacco Cessation and SHS Exposure Guideline • Talking points/FAQ’s • Order form/Resource list • “Ready to Quit Smoking? Ask me how.” pin • QuitLine Fax Referral Form • Prescription pad • QuitLine brochure • QuitLine magnet www.coloradoguidelines.org/tobacco 13

14. Tobacco Cessation Toolkit • Tools available through STEPP • Most important thing in this packet is the Guideline • You will notice it recommends you “Ask, Advise, Assess” your patients for both tobacco use and SHS exposure. • Next most important is QuitLine • Are you familiar? • Rx, fax referral, brochure www.coloradoguidelines.org/tobacco 14

15. Tobacco Cessation and Secondhand Smoke Exposure Guideline:Revision Process • Original: 2002, 1st revision: 2004 • Changes since 2004: • Nov 04:Colorado Amendment 35; constitutional amendment to raise cigarette excise taxes • Increased awareness and support for the 2A/1R • Jan 2006: QuitLine began to offer free NRT patches • June 2006: Surgeon General Report on Environmental Smoke Exposure • July 2006: Colorado Clean Air Act • New medications on market • 2006/07 Process: • 5 meetings • 9 MDs, 3 RN/clinicians, 1 pharmacist, 6 tobacco control experts/ quality specialists • National Guideline revision: Spring 2008 release www.coloradoguidelines.org/tobacco 15

16. The Tobacco Cessation and Secondhand Smoke Exposure Guideline:The 5As Intervention Model www.coloradoguidelines.org/tobacco 16

17. The Things We Know About: Tobacco Cessation • Policy works • Systematic approach works • Use of 5A intervention model through clinical guidelines works • Intense coaching for even short amount of time by any clinician works • Multiple interventions (prescription + coaching) work • Tools and access to tools www.coloradoguidelines.org/tobacco 17

18. The Things We Know About Tobacco Cessation in Clinical Practice:It May Not Be Working As Well As We ThinkIt Is • Family physicians are generally aware of clinical practice guidelines and most think guidelines are a positive trend in medicine (1998) • Only 44% reported using them • Among smokers who saw a doctor in the past year, 58.7% reported being advised to quit. (TABS 2006) • 31.7% of smokers who received advice reported that their doctor also referred them to a smoking cessation program. (TABS 2006) www.coloradoguidelines.org/tobacco 18

19. Tobacco Cessation Toolkit • Do these look like things you will use? • Would you like to set up training for the providers on this? www.coloradoguidelines.org/tobacco 19

20. Secondhand Smoke Toolkit www.coloradoguidelines.org/tobacco 20

21. Secondhand Smoke Toolkit/Materials • Training video for healthcare providers • Info on “4 Myths” • “ONE step” strategy to step outside • Communication tips for providers to use with parents • Tools for children and parents (brochures, QuitLine info, posters, video, etc) www.coloradoguidelines.org/tobacco 21

22. Secondhand Smoke Toolkit • Available from STEPP. • Go through tools or watch training video. • Materials based on focus groups with parents • Addresses their beliefs/misinformation • Tips on how to talk with patients • QuitLine is important resource www.coloradoguidelines.org/tobacco 22

23. Qualitative Research Focus Groups Family and pediatric practice staff Childcare providers Parents who smoke www.coloradoguidelines.org/tobacco 23

24. Healthcare Providers Key Findings Discussing SHS is part of their job and relatively easy More likely to discuss if contributing to child’s illness Time is a major barrier Interested in resources/toolkit with a “live” training www.coloradoguidelines.org/tobacco 24

25. Know SHS is dangerous and harmful If they can not see or smell smoke that is safe enough Kids are safe if they are 10’ feet away Believe ventilation will protect their kids Most protective during infancy None of them want their kids to smoke Most learn about SHS dangers from local TV news or reading newspapers Parents Key Findings www.coloradoguidelines.org/tobacco 25

26. Parents Barriers to Smoking Outside Cold outside Lazy Felt they could not quit smoking Health risks to children not readily apparent www.coloradoguidelines.org/tobacco 26

27. Four Myths and ONE Step DISTANCE MYTH VENTILATION MYTH ODOR MYTH QUIT MYTH www.coloradoguidelines.org/tobacco 27

28. Secondhand Smoke Toolkit • Does this look like something you can use? www.coloradoguidelines.org/tobacco 28

29. Mental Health Toolkit www.coloradoguidelines.org/tobacco 29

30. Mental Health Toolkit • The Need: In the U.S., 41% of persons who reported having recent mental illnesses also smoke cigarettes. Although quit rates for persons with mental illnesses are less than the general population, smoking cessation rates are still substantial. • The Experts: This tool kit was developed by The University of Colorado at Denver and Health Sciences Center (UCDHSC) research team, which is developing prevention and cessation strategies tailored to this population’s unique needs and building community partnerships to create sustainable prevention and cessation programs. www.coloradoguidelines.org/tobacco 30

31. Mental Health Toolkit • A combination of biological, psychological and social factors contribute to increased tobacco use among persons with mental illnesses. • This toolkit details psychiatric medication interactions and how to approach patients who are quitting (key message is to closely monitor patients) www.coloradoguidelines.org/tobacco 31

32. Mental Health Toolkit • The Tools: Walk through the tabs: • Background • Assessment/Stages of Change/Guideline • Specific Interventions and Information on Counseling • Relapse Prevention • Resources • References • Literature Review • Brochure (available through STEPPItems) • Guideline (specifically tailored for Persons with Mental Illnesses) • Revised QuitLine fax referral form for mental health patients • One page document to accompany toolkit for primary care practices www.coloradoguidelines.org/tobacco 32

33. Mental Health Toolkit • Key Information: • For stable depressed patients, you will have to watch for signs of deepening depression during quit attempts • Watch medications carefully, particularly with atypical antipsychotics • If you need help with specific medication issues, refer to community mental health providers • There may be questions about Chantix. We are watching the literature for further developments on use of Chantix for persons with Mental Illness. www.coloradoguidelines.org/tobacco 33

34. Questions on Mental Health Toolkit • If you have questions on this toolkit direct them to CCGC and we will consult with Jeanette Waxmonsky as needed. tobaccoinfo@coloradoguidelines.org www.coloradoguidelines.org/tobacco 34

35. Need more toolkits? • CCGC works with STEPP to make available larger quantities of toolkits to people who have completed this training. • If you are interested in obtaining toolkits in amounts that exceed the maximum order quantity on www.steppitems.com, please contact CCGC at tobaccoinfo@coloradoguidlines.org or (720) 297-1681. www.coloradoguidelines.org/tobacco 35

36. www.coloradoguidelines.org/tobaccoA Resource for You • Webinar recordings • Calendar of events • Training request forms • Current research • Funding opportunities • Professional development • Guideline • TRIA information www.coloradoguidelines.org/tobacco 36

37. CCGC Tobacco Webinars:Mark Your Calendar All webinars from 12-1 pm* • Mar. 4, 2008: What Colorado Physicians Need to Know about the QuitLine, presented by Dr. David Tinkelman • Mar. 18, 2008: Clinical Practice Funding Opportunities • Mar. 25, 2008: Clinical Practice Funding Opportunities (*repeat presentation 7:30-8:30 am) • Apr. 1, 2008: Tobacco Cessation for Persons with Mental Illnesses: Primary Care Strategies, presented by Drs. Jeanette Waxmonsky & Alexis Giese • Apr. 15, 2008: Stages of Change & Motivational Interviewing with Clinical Populations, presented by Dr. Heather LaChance • May 20, 2008: Pharmacotherapy for Tobacco Cessation: Treatment Update and Clinical Pearls, presented by Laura Hansen, RPA For more information on each webinar visit www.coloradoguidelines.org/tobacco and click on “Professional Development.” www.coloradoguidelines.org/tobacco 37

38. Visit:www.coloradoguidelines.org/tobaccoQuestions? tobaccoinfo@coloradoguidelines.org For a TRIA, contact:Emma at 303/962-8992 or egoforth@coloradoguidelines.org 38

39. Thank You for Your Time www.coloradoguidelines.org/tobacco 39