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Involving More Health Professionals in Tobacco Cessation: What Works. Connie Revell Deputy Director, Smoking Cessation Leadership Center May 18, 2006 National Network of Tobacco Cessation Quitlines. Cessation Partnerships. Helping Clinicians Become Tobacco Interventionists.

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Involving more health professionals in tobacco cessation what works l.jpg

Involving More Health Professionals in Tobacco Cessation: What Works

Connie Revell

Deputy Director, Smoking Cessation Leadership Center

May 18, 2006

National Network of Tobacco Cessation Quitlines

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Cessation Partnerships What Works

Helping Clinicians Become

Tobacco Interventionists

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The Smoking Cessation Leadership Center What Works

  • Robert Wood Johnson Foundation National Program Office

  • Housed at UCSF

  • About three years old

  • Director is Steven A. Schroeder, M.D., former RWJF president

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The Mission What Works

  • Increase the number of smokers who quit

  • Increase the number of clinicians who help them do it

  • Promote quitlines and 1-800 QUIT NOW as key strategy

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Eight Key Partnerships What Works

  • Nurses

  • Dental Hygienists

  • Pharmacists

  • Family Physicians

  • Emergency Physicians

  • Physician Assistants

  • Respiratory Therapists

  • Anesthesiologists

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Seven Key Projects What Works

  • JCAHO Smoking Cessation Project

  • Kaiser Permanente of Northern California

  • VA in the Vanguard

  • Make It Your Business Campaign

  • Wellpoint/Blue Cross California

  • Dana Farber Organized Labor Project

  • National Association of State Mental Health Program Directors

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Why the Focus on Quitlines? What Works

  • They work--calling a quitline can more than double the chance of successfully quitting

  • They are simple and easy to use

  • They save time

  • They are the missing part of a complete management plan for cessation

  • They are available everywhere

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And… What Works

  • They have made the difference in persuading clinician groups to become tobacco interventionists

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From National to State and Local Levels What Works

  • Most national groups have state constituent organizations

  • Work gets carried out through them in most cases

  • State groups, in turn, use district or component structure to carry out work plans

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How Our Message Has Evolved What Works

  • Expected more willingness to do the Five A’s

  • Barriers were ignorance and resistance

  • No one knew about quitlines

  • Almost universal readiness to try Ask-Advise-Refer approach

  • Availability of the single number and the card greatly increased chances of success

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Honing the Message What Works

  • Dr. Schroeder’s July 2005 JAMA article further refined the message

  • Of four responses to smoking patients, three are acceptable….

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The Three Choices What Works

  • Do the full Five A’s

  • Do a brief intervention (A-A-R including pharmaceuticals)

  • Work on change within your system

  • (Or some combination)

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The National Card What Works

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And Order Cards… What Works

  • Check the SCLC web site at

  • More than two million cards have now been ordered

  • The VA project is generating great demand

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Partnerships--A Way to Stretch Scarce Resources What Works

  • Partnerships can be greater than the sum of the parts

  • Population-based approaches are feasible with partnerships

  • Less visible clinician groups have shown more enthusiasm

  • We can make a big dent in the 46 million smokers

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The Four Questions Model What Works

  • Where are we now? (baseline)

  • Where do we want to be? (target)

  • How will we get there? (multiple strategies)

  • How will we know we are getting there? (measures)

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An Example: The Smoking Cessation Initiative of the ADHA What Works

  • Thirteen dental hygienists formed a task force

  • Leadership from elected president of ADHA

  • Support from Smoking Cessation Leadership Center

  • Expert facilitator

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How ADHA Answered the Four Questions What Works

  • Where are we now?– About a quarter of hygienists intervene with patients who use tobacco.

  • Where do we want to be? We can double that in three years.

  • How will we get there? Very broad work plan using state affiliates to deliver at the grass roots.

  • How will we know we are getting there? Develop an evaluation plan with baseline and one-year follow-up surveys.

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The ADHA’s SCI Communication Plan What Works

  • Developed a web site

  • Created a liaison in each state affiliate organization

  • Created scripts and protocols to help clinicians broach the subject of quitting with patients

  • Publicized the initiative through local channels and nationally through newsletter and meetings

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Examples of State Initiatives What Works

  • The New California Gold Rush

  • A version just was launched in New York

  • Minnesota, Hawaii, other states are interested

  • Pharmacy is establishing effort in each state

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And Now– The Place-Based Partnership What Works

  • The LA Cessation Initiative

  • Interest in other places such as Chicago, Washington, D.C.

  • Looking for triggers

  • Looking for ways to weave the various partners together into a comprehensive initiative in a particular place

  • How might you take advantage of this opportunity?

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Thank you! What Works