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The Role of the Respiratory Therapist in Tobacco Cessation. Steven A. Schroeder MD Director Smoking Cessation Leadership Center University of California, San Francisco. Smoking Cessation Leadership Center.
The Role of the Respiratory Therapist in Tobacco Cessation Steven A. Schroeder MD Director Smoking Cessation Leadership Center University of California, San Francisco
Smoking Cessation Leadership Center • A Robert Wood Johnson Foundation National Program Office—RWJF is a 30+-year-old, $8 billion health care foundation • Housed at UCSF • Begun in early 2003 • We have a staff of six • Primary mission is to train as many health care professionals as possible to identify smokers and provide early intervention
The Issue • 46 million Americans smoke • Half of regular smokers who do not quit will die as a consequence of this habit • Although 70 percent of them want to quit, less than 3 percent succeed each year • Advice of a health professional is a powerful motivator • Yet most health professionals do not intervene with smoking patients
ComparativeCauses of Annual Deaths in the United States Number of Deaths (thousands) Est. 200,000 per year for mentally ill and SA AIDS Alcohol Motor Homicide Drug Suicide Smoking Vehicle Induced Source: CDC
Key Strategies • We encourage leadership groups and institutions to improve their record on smoking cessation, emphasizing brief interventions • We form strategic partnerships around cessation, offering technical assistance and small grants • We work to broaden insurance coverage for cessation
Major Components of SCLC Work • Professional associations • Large health care institutions • Public face (AARP, labor, etc.) • Business and insurance • Public health • Mental health/substance abuse • State by state cessation partnerships • Quitline support and marketing
Why the Focus on Quitlines? • They work--calling a quitline can more than double the chance of successfully quitting • Many clinicians say the Five A’s are too complicated and time-consuming • Most clinicians seem unaware of quitlines, but when informed they are receptive
What is telephone tobacco counseling? • Individually tailored • Anonymous • Can be proactive • Structured counseling protocol --thorough, yet brief and focused
Why telephone counseling? • Convenient for smokers, and thus preferred over clinic by 75-85 percent • Easy to promote • Nationwide network • Services available in several languages
Are Quitlines a Panacea? • Absolutely not, but they offer a shortcut that allows far more clinicians to become interventionists • Smokers prefer quitlines by large margins • Some quitlines are better than others • We all need to work to improve their quality and consistency • They provide a population-based alternative that can make a dent in the 46 million smokers
A Great Breakthrough • Tommy Thompson initiative In February 2004 made single router number possible • National effort to promote national number, 1-800 QUIT NOW
The Bottom Line • Every clinician should do something about cessation • Respiratory Therapists are uniquely positioned to identify smokers and provide early intervention
Who Are Some of SCLC’s Partners? • Tobacco Free Nurses • Pharmacy Partnership for Tobacco Cessation • American College of Emergency Physicians • JCAHO • Dana Farber Cancer Center--Organized Labor • American Academy of Family Physicians • Kaiser Permanente of Northern California • American Academy of Physicians’ Assistants • American Association of Respiratory Care
The Partnership Prototype • American Dental Hygienists Association represents the nation’s 130,000 dental hygienists. • SCLC held a meeting in September 2003. • Group agreed on baseline– 25 percent of hygienists now intervene with their clients regarding tobacco. • Target– 50 percent in three years.
Expanding on the Prototype--Pharmacy • 130,000 community pharmacists and 160,000 certified pharmacy technicians • Held a summit of 31 pharmacy organizations in September 2004, resulting in action plan, creating Pharmacy Partnership for Tobacco cessation • Set goal of increasing over 2 years from 6 to 20% the number of pharmacists who intervene with smoking patients • Grant to American Society of Health-System Pharmacists to carry out plan
Next Steps for SCLC • Connect health professionals to quitlines through partnerships– respiratory therapists are key • Improve quitline use and capacity • Explore insurance coverage issues • Focus on underserved populations, including mental health and substance abuse • Normalize cessation interventions in health professions
A Way to Stretch Scarce Resources • Partnerships can be greater than the sum of the parts • Population-based approaches are feasible with partnerships • We can make a big dent in the 46 million smokers
Power of Intervention • ⅓to ½ of the 46 million smokers will die from the habit. Of the 32 million who want to quit, 10 to 16 million will die from smoking. • Increasing the 2.5% cessation rate to 10% would save 2.4 million additional lives. • If cessation rates rose to 15%, 4 million additional lives would be saved. • No other health intervention could make such a difference!
Why Respiratory Therapists? • Uniquely positioned to identify patients in a variety of care settings • Provide therapy to patients that allows for a key “teaching moment.” • Well trained professionals with expert knowledge in lung physiology • Have a core mission of preventing lung disease,… tobacco cessation has a profound impact on this core mission
Why AARC? • The Professional Organization for Respiratory Therapists • Network of 40,000 members • Network of State Affiliates • Ability to roll out communication plans and develop educational products • Tobacco cessation fits with core mission
Roland Romano,CTTS,MACC,RRT-NPS Tobacco Treatment Program Coordinator Saint Barnabas Medical Center Livingston, NJ
AARC Tobacco Cessation Summit • Conducted in October 2005 • Convened 15 experts from across the country to develop an action plan on the roll of the respiratory therapist in tobacco cessation • Baseline survey provided key information that led to the primary outcome measurement
AARC Survey Data838 Responses • Is smoking cessation counseling provided in your institution? • Yes-83% • No-17%
AARC Survey Data793 Responses 2. How are smokers identified? • Bedside patient assessment- 70% • Admission- 61% • MD referral- 43% • Patient request- 40% • Other- 12%
AARC Survey Data762 Responses 3. Who provides smoking cessation counseling? • Respiratory Therapists- 74% • RNs- 49% • MDs- 16% • Pulmonary Rehab 7% • Social Service 7% • Mental Health Professionals- 5% • Other- 17%
AARC Survey Data723 Responses 4. In hospital smoking cessation includes: • Basic information- 91% • Brief counseling- 67% • Personal counseling- 34% • Quit line referral- 41% • Nicotine replacement therapy- 50% • Bupropion prescribing- 19% • Other- 13%
AARC Survey Data765 Responses 5. What percentage of your RT staff are currently involved in smoking cessation? • None- 25% • 1%-10%- 26% • 11%-25%- 9% • 26%-50%- 6% • 51%-75%- 7% • 76%-100%- 26%
AARC Survey Data784 Responses 6. What percentage of your Respiratory Therapists are smokers? • 0%-10% 62% • 11%-20% 20% • 21%-30%- 11% • 31%-40%- 5% • > 40% 3%
AARC Survey Data747 Responses 7. Would your CEO be if favor of using RTs to improve smoking cessation counseling in your organization? • Yes- 92% • No- 8%
Primary Outcome Measurement Reduce the number of facilities who report that 0% of their Respiratory Therapists are involved in Tobacco Cessation by 5% per year over 3 years.
Key Strategies • Be an advocate for clean air • Promote non smoking RTs • Increase awareness regarding reimbursement • Engage managers to be leaders in the process • Develop a network of facility “Champions” • Provide tobacco cessation education for RTs • Organize a network of resources regarding tobacco cessation
Call to Action • Sign up for the Tobacco Free Lifestyle Roundtable • Roundtable will progress to an AARC Specialty Section with a threshold of 350 members • Recommend a “Champion” for your facility • Utilize AARC tobacco cessation resources • Participate in AARC educational programs as they are offered • Stay engaged regarding new developments as they are publicized through the AARC