Using Provider Networks to Integrate Tobacco Cessation into Chronic Disease Management Programs

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Using Provider Networks to Integrate Tobacco
Cessation into Chronic Disease Management Programs

• Cindy Tworek, PhD, MPH, MS
• Behavioral Scientist, Center for Tobacco
  Independence
• Portland, ME
• Tworec_at_mmc.org
• Tobacco Cessation Leadership Network
• May 11, 2006

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CTI

• CTI delivers Maines comprehensive statewide
  tobacco treatment program supported by the
  Partnership for A Tobacco-Free Maine (PTM)
• PTM Treatment Initiative
• Maine Tobacco HelpLine
• Nicotine Therapy (NRT) Program
• Professional Education and Training

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The CARE Model

• HelpLine fax referrals integrate
• COMMUNITY (resources policies)
• HEALTH SYSTEM (health care organization)
• AND
• SELF-MANAGEMENT (provide tools and support)

• FOR PRODUCTIVE INTERACTIONS AND IMPROVED OUTCOMES

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The HelpLine Reaches Maine Smokers with chronic
disease

• 20.5 Self-report COPD or asthma
• 6.3 Self-report diabetes
• 4.3 Self-report coronary artery disease

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Intervention for smokers with chronic disease

• Implement a community-based practice intervention
  
• Utilize resources to engage practices or health
  clinics within the community
• Routinely identify tobacco use and offer
  treatment to increase quit rates
• Gain support and buy-in to institutionalize the
  process among providers and clinics

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Intervention for smokers with chronic disease

• GOAL To integrate tobacco treatment into
  comprehensive chronic illness care

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Using Provider Networks to Integrate Efforts

• Maine Network for Health (MNH)
• Maine Medical Center Physician Hospital
  Organization (MMCPHO)
• Maine Primary Care Association (MPCA)

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Using Provider Networks to Integrate Efforts

• Target practices or health clinics within the
  network to participate
• Target chronic disease - may be specific
  disease(s)
• Target smoking patients

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Using Provider Networks to Integrate Efforts

• Document Tobacco Status
• Assess Quit interest
• Provide Tobacco Treatment (provide brief
  counseling, prescribe medication if appropriate
  NRT, Zyban/Wellbutrin, etc.)
• Fax referral to the HelpLine (MTH)

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Maine Network for Health

• MNH chose a collaborative model to pilot the
  implementation of HelpLine fax referrals for
  smokers with chronic disease
• 12 COPD practices participated in 3 learning
  sessions to help integrate this practice-based
  intervention
• MNH provided TA and site visits to further assist
  practices with implementation and integration

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Maine Medical Center Physician Hospital
Organization

• MMCPHO chose to target adult smokers with
  diabetes and cardiovascular disease
• MMCPHO maintains clinical improvement registries
  (CIRs) to track tobacco treatment efforts at each
  individual office, facilitating the integration
  process
• As part of quality improvement, the MMCPHO offers
  monetary incentives to practices for documenting
  tobacco status, assessing quit interest, and
  faxing referrals to the MTH

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Maine Primary Care Association

• MPCA chose to send out invitation letters to
  rural health clinics to pilot implementation of
  HelpLine fax referrals for smokers with chronic
  disease
• Two large rural health clinics were selected to
  pilot the implementation of this chronic disease
  intervention
• MPCA provided TA and site visits to further
  assist with implementation and integration

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Practice-based outcomes

• MNH
• MMCPHO
• MPCA
• Provider networks are working with practices or
  community health clinics to integrate tobacco
  treatment into comprehensive illness care among
  smokers

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Accessing Statewide Resources

• Partnership for A Tobacco-Free Maine (PTM) has a
  Tobacco Treatment Services Guide by County
• Contact CTI 207-662-7154
• CTI website http//www.tobaccoindependence.org
• Maine Tobacco HelpLine has additional materials
  (for smokers, providers, and employers)