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If They Won’t Come to You… Reaching the Hard to Reach

If They Won’t Come to You… Reaching the Hard to Reach. “Infiltrating the Systems” Catherine Suiter, M.Ed. Statewide Tobacco Cessation Coordinator Vermont Association of Hospitals and Health Systems. The Systems. Hospitals Outpatient Clinics The Workplace. Vermont Cessation Program.

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If They Won’t Come to You… Reaching the Hard to Reach

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  1. If They Won’t Come to You…Reaching the Hard to Reach “Infiltrating the Systems” Catherine Suiter, M.Ed. Statewide Tobacco Cessation Coordinator Vermont Association of Hospitals and Health Systems

  2. The Systems • Hospitals • Outpatient Clinics • The Workplace

  3. Vermont Cessation Program • Clinically based program • Local Tobacco Coordinator • At all 14 hospitals in the state including VA • Provides local classes and 1-1 counseling • Provides access to free or low cost NRT • Vermont Quit Line

  4. Cessation System

  5. Snapshots of Vermont • Population 613,000 • 25% in Burlington area • Outside the city • Very rural • 44 people /sq. mile • Geography and weather impede travel

  6. Snapshots of Vermont • Fours years into program • 6500 clients • 12,000 NRT coupons distributed • Smoking prevalence dropped from 22.4 to 19.5% • 17% Quit Rate at one year

  7. More Snapshots

  8. The Hard to Reach • “We have plucked the low hanging fruit” • If they do not come to us, we will go to them • In hospitals • In clinics • In the work place

  9. Nicotine Intervention in the Hospitalized Patient Mary Anne Riley, RRT Nicotine Cessation Coordinator, Springfield Hospital

  10. The Facts: 70% of current smokers want to quit. Smokers rate physician’s advice as incentive to quit smoking “The influence your role as a health care provider carries in helping smokers quit cannot be overstated. A clinician’s advice to quit improves success in maintaining abstinence. With the addition of a few minutes of counseling, the success rate doubles “ U.S. Public Health Service (2000)

  11. Develop a system to identify current smokers admitted to ER ICU PRE-OP MEDICAL/SURGICAL MATERNITY PSYCHIATRY DISCHARGE PLANNING Develop a flow sheet or charting system to document initial visit and follow-up visits – make it accessible to other members of the patient’s care team. How do you find these patients?

  12. Nicotine consult to the cessation coordinator, or department in charge of providing this service. • NRT order • Educate staff, physicians, and anyone who may initiate a consult.

  13. What do you say? • Do they want to quit ? Provide the 5 A’s • Are they only interested in help to control their cravings while in the hospital? Provide the 5 R’s • NO PREACHING ALLOWED! Just talk to them and find our how you can help by listening.

  14. THE 5 A’s ASK ADVISE ASSESS ASSIST ARRANGE THE 5 R’s RELEVANCE RISKS REWARDS ROADBLOCKS REPETITION what do you say continued… or…

  15. Provide feedback to their statements, concerns, or possible barriers to success. • NRT- what is available in the hospital setting. • Ask open-ended questions rather than “yes” or “no” ones. • Provide written education if requested, at least leave a contact phone number and cessation class information for follow-up after discharge.

  16. Treating Tobacco Use and Dependence as a Chronic Disease:Developing Office-Based SystemsEvelyn Sikorski, CSW, CEAP, TTSFletcher Allen Health Care - Burlington VT

  17. Cessation CounselingPrimary Care Setting • Provide motivational interview to patients after advice to quit • Evening appointments for individuals and couples • Model intervention with physician to increase skill set • Stock readiness literature and posters for exam rooms

  18. Recognizing and Applying Best Practice Guidelines • Tobacco dependence is itself a disease and not simply a risk factor • Tobacco use and dependence is a chronic disease • Tobacco use and dependence can be treated effectively • Local resources exist to assist current tobacco users

  19. STEPS to create an effective IDENTIFICATION system • Identify key partners (AHEC) • Organize a team and designate a leader • Conduct a self-assessment of the current tobacco treatment system • Develop a site specific plan • Implement a system to address tobacco cessation

  20. Referral Pads

  21. Infiltrating the Worksite Jamie Balch, MSN Northwestern Medical Center, St. Albans, Vermont

  22. Building Within • Local Resources • Local Partners • Local Providers • Local Employers

  23. Cardiovascular Health Improvement Program • Evidenced Based Screening Program • Outcome driven • Replicable • Successful!

  24. CHIP Screening Report

  25. Worksite Pilot • Selling the idea • Funding • Implementation • Evaluation • Success and Obstacles • From here

  26. from here… • Broader Implementation • Community Sites • Worksite Marketing • Links to local chronic disease initiatives • Statewide Initiatives • Ladies First/Wise woman • Networking with additional service areas • Working toward a broader registry

  27. Inpatient settings Nursing homes Staff Clinics Planned Parenthood Free clinics Worksite Food shelf Salvation Army Urban ministries More Opportunities to “Infiltrate”

  28. Remaining Gaps • 18- 24 year olds • Pregnant women

  29. Questions?

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