Implementing a cessation program in public health care clinics – 8/16/05

Q:

One of your peers would like to obtain information from states currently working to implement the 5 As in primary public health care clinics. If your state is currently involved in this effort, please pass on any written protocols, lessons learned, or other helpful resources you may have.

A:

1. Alabama: The Alabama program is partnering with the State Perinatal Program to provide 5 As training to healthcare providers (delivering physicians). The one hour training is accredited by the state's Nursing Board and the Board of Dental Examiners for Hygienists. We also provided the training to dentists as a result of a survey we conducted to determine the use of the 5 As in dental practice statewide. We would be happy to share the presentation and the survey tool, if this would be of use.
    
2. Arizona: Arizona has a continuing education program for healthcare professionals on tobacco dependence treatment. Click for information on the program.
    
3. Guam: The Tobacco Free Guam Program - Department of Public Health and Social Services has conducted a basic and instructor level training on a brief intervention tobacco cessation method developed by the University of Arizona - HealthCare Partnership.
    
   We plan to train as many of our main clinic and WIC staff to start over the next few months and then move on to our other staff in Public Assistance, Social Work and Senior Citizen Programs and satellite community health centers (clinics). Several staff from our public health main clinic, WIC Program, the Guam Department of Mental Health and Substance Abuse, Pacificare Asia Pacific (local HMO clinic) and the University of Guam have also been trained. All as part of our ongoing collaboration and partnership within our Coalition for a Tobacco Free Guam,(led by the local American Cancer Society and supported by us the Tobacco Free Guam Program - Department of Public Health and Social Services). Maybe they can contact us regarding the details of what we plan to do in our clinics and the University of Arizona for data on the appropriateness of their cessation method (I have their contact info).
    
4. Kentucky: The Kentucky Cancer Program at the University of Louisville, with funding from the Kentucky Department for Public Health Tobacco Prevention and Cessation Program, has been implementing statewide health provider education on Treating Tobacco Use and Dependence since 2002. Our principal efforts have been through a very successful video self-study program, Providers Practice Prevention: Treating Tobacco Use and Dependence, with nearly 3000 participants including physicians, dentists, nurse practitioners/midwives, physician assistants, dental hygienists, and psychologists. The continuing education (CE) offering includes a 36-minute video featuring Kentucky providers and a toolkit based on the 5 As including office tools, counseling aids, and patient education materials. The program has been provided free of charge to participants upon request and includes two hours of CE credit for completion. This offering has been endorsed by all major medical organizations in the state.
    
   More recently, education efforts have expanded to trainings lasting for 1-2 hours done on-site for internal medicine and specialty physicians, family physician and OB/GYN residency programs, community dentists and dental hygienists, allied health professionals, physician assistants, nurses, dental residency programs, and medical and dental hygiene students. Some of these trainings have incorporated a component with the Standardized Patient Program at the University of Louisville. Three scenarios have been developed and are used with each participant interacting with a trained "patient" who is either willing to quit, considering quitting or completely unwilling to quit. Feedback is provided to the participant by the standardized patient and course facilitators. This practice opportunity has been very valuable for beginning to use the newly attained knowledge and skills taught in the lecture beforehand.
    
5. Michigan: Michigan is planning to conduct three tobacco conferences for health care providers to take place in August and September 2005. All three conferences will provide information on effective tobacco interventions for busy clinicians, including the 5 A's. Participants will learn educational techniques and tools to provide patient-focused, individualized tobacco interventions for a broad range of patients. The locations of the conferences will allow the opportunity for all health care providers in the state to attend a conference within a reasonable distance of their location. The conferences are free and offer free CME's.
    
6. Utah: Click for a website where we have info about most of our efforts.
    
7. West Virginia: West Virginia has a program through the State Medical Association and West Virginia Chapter of the American Academy of Family Physicians that offers a free continuing education program (3 hours credit through AAFP) that emphasizes incorporation of cessation counseling and the 5As, AHRQ Protocol. These trainings and/or individual practice kits are made available to physicians, dentists, counseloer, nurses, pa's, managers, other office or clinic staff, etc.. Over 600 persons have completed this training statewide. For more information contact:
    
   Kathy Danberry, Cessation Program Manager
   Division of Tobacco Prevention
   West Virginia Bureau for Public Health
   Office of Epidemiology and Health Promotion
   350 Capitol Street - Room 206
   Charleston, WV 25301-3715
   kathydanberry@wvdhhr.org
   Phone (304) 558-6260
   Fax (304) 558-2285
    

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   Additional resources compiled by TTAC:

• AHRQ pocket tool for nurses
  The Department of Health and Human Services released an evidence-based tool to support nurses in helping their patients quit smoking. The Agency for Healthcare Research and Quality (AHRQ) worked with Tobacco Free Nurses to create the pocket guide Helping Smokers Quit: A Guide for Nurses.
   
• Tobacco Free Nurses website
  Population-specific guidelines, case studies, and motivating suggestions for patients can be found on the Tobacco Free Nurses website. Additional resources and products for health professionals can be found on the Tobacco Free Nurses resources page.
   
• DHHS Tobacco Cessation Website Resources
  Clinical Practice Guideline – Treating Tobacco Use and Dependence
  Treating Tobacco Use and Dependence, a Public Health Service-sponsored Clinical Practice Guideline, contains strategies and recommendations designed to assist clinicians; tobacco dependence treatment specialists; and health care administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence. The recommendations were made as a result of a systematic review and analysis of the extant scientific literature, using metaanalysis as the primary analytic technique. A Quick Reference Guide for Clinicians, containing strategies and recommendations from the full report, is available.
   
  Clinician Tearsheets/Posters
  DHHS has made clinician tearsheets for primary care and prenatal populations and “You Can Quit” posters available in both English and Spanish on its tobacco cessation website.
   
  Achievements in Tobacco Cessation
  Also available on the DHHS website are Achievements in Tobacco Cessation Case Studies.
   
• University of Wisconsin Center for Tobacco Research and Intervention
  This website contains practical tools for health care providers and additional training resources.
   
• Center for Tobacco Cessation
  This website contains a working bibliography of cessation research, divided up into population groups, along with links to the Clinical and Community Guidelines and a page on recent research and trends.
   
  CTC Medicaid Toolkit
  Also on the CTC website is a Medicaid toolkit that addresses why states should address more in smoking cessation benefits.
   
• Reimbursement for Smoking Cessation Therapy: A Healthcare Practitioner’s Guide
  Reimbursement for Smoking Cessation Therapy: A Healthcare Practitioner’s Guide provides information to healthcare providers and their administrative staffs on how to obtain reimbursement for smoking cessation treatment and counseling. It contains advice for providers who wish to maximize benefits for smoking cessation, find their way around coverage deficiencies, and advocate effectively for adequate coverage.
   
• Leading the Way: Helping Our Patients Be Tobacco Free
  Leading the Way: Helping Our Patients Be Tobacco Free is a carefully researched and developed comprehensive tobacco control curriculum available to dental hygiene faculty at no charge that includes a faculty guide, six training modules, and a useful toolbox.
   
• Health Care Providers’ Tool Kit for Delivering Smoking Cessation Services
  This manual is designed for physicians, medical office personnel and medical group staff. It seeks to help establish office-based systems to track smoking status, conduct cessation interventions with patients and refer patients to additional resources for more intensive assistance in their quit attempts.
   
• Smoke Free Families Website
  Smoke Free Families provides information for care providers to help their pregnant patients quit smoking.
   
• Alliance for the Prevention and Treatment of Nicotine Addiction
  APTNA provides training, consultation and resources to healthcare providers in Virginia in order to assist them in implementing research-based clinical practice guidelines designed to reduce tobacco use among their patients. Their website contains a tool kit for use when educating healthcare providers on implementating the Public Health Service Clinical Practice Guidelines.
   
• ACOG Smoking Cessation Website
  The American College of Obstetricians and Gynecologists has a smoking cessation website which contains information for both providers and patients.
   
• The Pacific Center on Health and Tobacco
  The Pacific Center on Health and Tobacco has a resource page that includes several reports, including “Build a Financial Infrastructure: Health Plan Benefits and Provider Reimburement” and “Linking a Network: Integrating Quitlines with Health Care Systems.”
   
• Professional Assisted Cessation Therapy (PACT) Website
  The PACT website contains information for health professionals on helping their patients quit smoking, as well as information on reimbursement and resources for patients.
   
• Colorado Tobacco Control Program’s Health Care Provider Information
  The Colorado Department of Public Health and Environment’s Tobacco Control Program website contains information and tips for using the 5A’s counseling method.

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