Promoting Tobacco Cessation

1
Promoting Tobacco Cessation
Sterling M. Fulton-Smith, MHA Grants Manager,
TUPC
2
Advice from a provider will lead the patient
along the path to quitting
3
Overview

• The Role of the Healthcare Provider
• Counseling
• Ask, Advise, Refer (1-800-QUIT-NOW)
• Consider Fax Referral
• Counseling Reimbursement
• Cessation Counseling in Schools

4
Scope of Problem in NC Cost of Tobacco

• In North Carolina
• Total health care costs from smoking 2.46
  billion
• Portion covered by state Medicaid program 769
  million
• Total losses in productivity caused by smoking
  3.30 billion

Campaign for Tobacco-Free Kids, The Toll of
Tobacco in North Carolina Fact Sheet accessed
May 19, 2008 at http//www.tobaccofreekids.org/rep
orts/settlements/toll.php?StateIDNC
5
Cessation Programs

• Breathe Easy Live Well
• You Quit Two Quit
• Old North State Medical Society
• The Tobacco Control Branch
• NCSTEP

6
The Role of the Healthcare Provider
Increasing Tobacco Use Cessation
Clinicians play an important role in promoting
tobacco cessation among patients
7
Efficacy of Physician Advice to Quit

• Abstinence Rate
• No advice 7.9
• Physician Advice 10.2
• Patients expect healthcare providers to ask about
  tobacco use and advise them to quit
• Source Treating Tobacco Use and Dependence,
  USDHHS, Public Health Service, 2000

8
The 5As of Tobacco Cessation

• Ask about tobacco use
• Advise patient to quit
• Assess readiness to quit
• Refer (1-800-QUIT-NOW)
• Assist in quit attempt
• Arrange follow-up

9
Vital Signs Create a Reminder System

• Include tobacco use in other medical / dental
  advice
• Use an identification system
• Stamp, Sticker, EMR
• Reminder systems are key to helping busy
  providers incorporate the 5As into their busy
  schedules. It gets others in the office involved
  with process of asking all patients about tobacco
  use, at every visit.

10
The 5As of Tobacco Cessation

• Ask about tobacco use
• Advise patient to quit
• Assess readiness to quit
• Refer (1-800-QUIT-NOW)
• Assist in quit attempt
• Arrange follow-up

11

• 1-800-QUIT-NOW (1-800-784-8669)
• 8 a.m. 3 a.m. - 7 days a week
• Toll-free
• Confidential
• All North Carolinians - youth and adult
• Proactive calls by Quit Coach
• Fax referral
• Available in multiple languages

12

• QuitlineNC helps patient ready to
• STAR
• - Set a quit date (within 2 weeks)
• - Tell family, friends, coworkers
• - Anticipate challenges to quitting
• - Remove tobacco products from
• environment
• Make up to three follow-up calls,
• Discuss pharmacotherapy, refer back to HCP,
• Encourage those not ready to set a quit date to
  call back
• Four call program is evidence-based

13
QuitlineNC Fax Referral
14
ARRANGE

• Patients ready to quit within 30 days

15
QuitlineNC Outcomes Report

• Tool to follow patient progress with your advice
  to quit / utilize Quitline services
• Most useful in clinic setting with dedicated fax
  machine/staff to retrieve reports
• Outcomes Report information includes
• Accepted services
• Declined services
• Unreachable

16
(No Transcript)
17
What is QuitlineNC?
18
How does QuitlineNC work?
19
www.quitlinenc.com
20
Counseling Coverage in NC
21
Counseling Coverage in NC

• Medicaid added two CPT codes Jan. 1, 2009
• 99406 3-10 minutes
• 99407 gt 10 minutes
• Private payer benefits are subject to specific
  plan policies. Before providing service, benefit
  eligibility and payer coding requirements should
  be verified.
• Medicare, BCBSNC, and State Health Plan also
  reimburse these codes

22
Dental Providers

• The American Dental Associations position
  statement on tobacco urges its members to become
  fully informed about tobacco cessation
  intervention techniques to effectively educate
  their patients to overcome their addiction to
  tobacco.
• Although tobacco interventions are not usually a
  covered benefit, the ADA insurance code D1320
  (tobacco counseling for the control and
  prevention of oral disease) could be used, if
  appropriate.

23
Coverage for Counseling

• For more information see Medicaid Bulletins
• Jan 2009 http//www.dhhs.state.nc.us/dma/bulletin
  .htm
• Oct.2008 http//www.ncdhhs.gov/dma/bulletin/1008b
  ulletin.htm
• www.endsmoking.org

24
Counseling by the School Staff

• Coaches
• School Nurses
• Teachers and Administrators

25
Coaches Can Influence Youth

• Sports activities present great opportunities to
  reach young people.
• Young athletes learn to make important health
  decisions related to tobacco use and physical
  activities.

26
School Nurses

• School based cessation counseling
• ALA - N-O-T program
• QuitlineNC
• Or other cessation programs

27
Teachers and Administrators Cessation in the
schools

• State law now requires every school district in
  NC to adopt and implement a 100 tobacco-free
  schools policy (effective August 2008)
• Work with staff in the schools to increase
  compliance of the 100 Tobacco Free Law.

28
Take-Home Message

• The Role of the Provider
• Counseling
• Ask, Advise, Refer (1-800-QUIT-NOW)
• Consider Fax Referral
• Counseling Coverage in NC
• Counseling in Schools