The Role of the Respiratory Therapist in Tobacco Cessation

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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

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Smoking Cessation Leadership Center

• A Robert Wood Johnson Foundation National Program
  OfficeRWJF 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

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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

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Comparative Causes 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
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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

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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

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Why the Focus on Quitlines?

• They work--calling a quitline can more than
  double the chance of successfully quitting
• Many clinicians say the Five As are too
  complicated and time-consuming
• Most clinicians seem unaware of quitlines, but
  when informed they are receptive

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What is telephone tobacco counseling?

• Individually tailored
• Anonymous
• Can be proactive
• Structured counseling protocol --thorough, yet
  brief and focused

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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

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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

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A Great Breakthrough

• Tommy Thompson initiative In February 2004 made
  single router number possible
• National effort to promote national number,
• 1-800 QUIT NOW

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The National Card
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The Bottom Line

• Every clinician should do something about
  cessation
• Respiratory Therapists are uniquely positioned to
  identify smokers and provide early intervention

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Who Are Some of SCLCs 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

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The Partnership Prototype

• American Dental Hygienists Association represents
  the nations 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.

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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

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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

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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

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Power of Intervention

• ? to 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!

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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

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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

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Roland Romano, CTTS,MACC,RRT-NPS

• Tobacco Treatment Program Coordinator Saint
  Barnabas Medical Center Livingston, NJ   

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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

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AARC Survey Data838 Responses

• Is smoking cessation counseling provided in your
  institution?
• Yes-83
• No-17

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AARC Survey Data793 Responses

• 2. How are smokers identified?
• Bedside patient assessment- 70
• Admission- 61
• MD referral- 43
• Patient request- 40
• Other- 12

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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

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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

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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

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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
• gt 40 3

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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

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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.

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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

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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