a presentation for

[INSERT EVENT/ORGANIZATION][INSERT DATE]

[INSERT PRESENTER NAMES/ORGS]

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Make Tobacco Your Priority!

Objectives• Understand the burden of tobacco on Alaskans• Learn how systems change increases positive

outcomes in healthcare settings• Learn about the Tobacco Prevention and Control

Program and its partners’ effort to create a 100% tobacco-free Alaska (Mission 100)

• Identify how Mission 100 can help your organization reduce tobacco use

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• [INSERT LOCAL PHOTO OR OTHER LOCAL-BASED CONTENT IF DESIRED]

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THE BURDEN OF TOBACCO ON ALASKANS

Reviewing the Data

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Reducing Tobacco UseSaves Lives

Adult Smoking Prevalence, 1996 - 2012

Source: Alaska Tobacco Facts, 2014; BRFSS, 1996-2012

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Preventing Youth Initiation of Tobacco Use Saves Lives

Youth Smoking Prevalence, 1995 - 2013

Source: Alaska Tobacco Facts, 2014; YRBS, 1995-2013

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Reducing Tobacco Use Saves Lives … and Money

Findings from the Alaska Tobacco Prevention and Control Program

Source: Alaska Tobacco Prevention and Control Program Annual Report, FY 2012

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Impacts of Tobacco Use

Source: Alaska Tobacco Facts, 2014; Alaska Bureau of Vital Statistics, 2011

Alaska Deaths Due to Selected Causes, 2011

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The Cost of Tobacco Use

Source: Alaska Tobacco Prevention and Control Program Annual Report, FY 2012

How much does tobacco cost Alaska each year?

Costs of Tobacco Use

Tobacco Revenue

Investment in Prevention

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More Work to Be Done

Source: Alaska Tobacco Facts, 2014; BRFSS, 2012

Tobacco-Related Disparities: Certain Populations Have Higher Prevalence

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[insert local data if available]

• [See TPC’s website for local data]

Regional Profiles (scroll down to Regional Profiles)http://dhss.alaska.gov/dph/chronic/pages/tobacco/default.aspx

Region Specific Datahttp://dhss.alaska.gov/dph/Chronic/Pages/Tobacco/regional.aspx

[Title of chart or table]

Source: [source of data]

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ALASKA TOBACCO PREVENTION AND CONTROL

How a Comprehensive Program Reduces the Burden of Tobacco

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The Alaska Tobacco Prevention and Control Program

Vision

For All Alaskans toLive Healthy and

Tobacco-free Lives!

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TPC Program Goals

Four goals guide a comprehensive program:

1. Prevent initiation of tobacco use

2. Help tobacco users quit their addiction

3. Eliminate exposure to secondhand smoke

4. Eliminate tobacco-related health disparities among population groups, including:

– Alaska Native People– People of Low Socioeconomic Status (SES)– Young Adults– Pregnant Women

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Addressing Tobacco Use: Public Health Model

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ADDRESSING TOBACCO USE THROUGH HEALTHCARE SYSTEMS CHANGE

How healthcare providers can help people quit tobacco and prevent others from becoming addicted

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Helping Alaskans Quit For Life

Alaska’s healthcare providers play a critical role in helping people quit tobacco.• At least 70% of smokers see a physician annually• Advising a tobacco user to quit increases the odds of

quitting successfully• Healthcare providers with the right tools (protocols,

resources and billing incentives) can make an impact on all patients who use tobacco.

• Tobacco cessation counseling and medication are safe, effective and reimbursable by Medicaid, Medicare, and most health plans

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Tobacco Cessation and Prevention Promotes Healthier Alaskans

Reducing tobacco use in healthcare settings:• Improves patient, staff and public health• One of the most cost-effective clinical preventive

services• Integral part of the reforms of the Affordable Care

Act: Essential Benefits and Meaningful Use• Important quality measure for the Joint

Commission, GPRA, and HRSA• Increasingly reimbursable

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Healthcare Systems Change

Healthcare systems change to address tobacco dependence has three goals:• Make it easy to help clients quit tobacco• Prevent others from ever starting to use tobacco• Protect everyone on the campus (patients, staff and

visitors) from the harms of secondhand smoke

All health organizations in Alaska have the opportunity to implement best practices and utilize available resources for tobacco cessation and prevention.

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Clinical Practice Guidelinesfor Treating Tobacco Use and Dependence

• Ask, Advise, Refer and Document in electronic health records (EHR)

• The right pharmacotherapy and counseling

• Consistent reimbursement for eligible services

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Best Practices for Addressing Tobacco Use

• Ask, Advise, Refer (AAR)• Document (in EHR)• Tobacco-free campus policy• Pharmocotherapy and counseling

services• Billing and reimbursement

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Brief Interventions Can Makea Difference

• 70% of smokers want to quit• 3 in 5 current smokers have attempted to quit in

the last 12 months• Quit attempts among Alaska Native smokers

increased from 59% (2001) to 65% (2010)• Providers can significantly increase patients’

likelihood of quitting with a Brief Intervention (Ask, Advise, Refer)

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Defining Ask, Advise, Refer

• Ask | Ask about tobacco use at every visit

• Advise | Conduct a brief 3 minute intervention

• Refer | Refer to cessation resources for more intensive treatment

ASK

• Screening– Type and use patterns– Every patient, every visit

• Beyond the Basics: Interventions– “Are you still using tobacco?”– “You were chewing/smoking last time you were

here, are you still using tobacco?”– “We noted that you smoke a pack a day, is that still

true?”

ASK: Motivation to QuitInitial Visit• “What are your feelings about quitting tobacco?”• “How do you think attempting to quit would go for you?”• “What lifestyle changes might you need to make if you

decided to quit?”• “What would be the hardest thing about quitting tobacco?”

Follow-up Visits• “You were thinking about quitting last time we saw you,

what are your feelings about quitting today?”• “Did you try to quit since we saw you last?”

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ADVISE

• Whether coming in to remove a fishhook, an inhaler refill or a pre-operative visit, advise the patient to quit tobacco.

• Make it personal– What motivates them to quit?– Ask open-ended questions– Help patients find reasons to quit

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REFER

• Be direct!• Ensure clients know their options• Make the referral

– Local / in-house cessation program– Alaska’s Tobacco Quit Line– Online resources– Fax referral (Quit Line reaches out to client)– Electronic referral through EHR

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• Free counseling and medication– Fax or electronic referral includes update to referring

provider after 30 days– Clients can call on their own at any time– Scheduled follow-up calls from Quit Coach– Text to Quit: receive SMS messages from Coach– Includes Nicotine Replacement Therapy (NRT)– Expanded services available for pregnant women

• 30% of QL callers reported success at 30 days

REFER: Alaska’s Tobacco Quit Line

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Alaska Quit Line Coaches are Part of the Patient’s Medical Team

Quit Coaches are trained to assist Alaskans in quitting tobacco

“They were helpful.They called consistently.

They did not judge.They were there to listen

and give advice. ”

“They were helpful.They called consistently.

They did not judge.They were there to listen

and give advice. ”

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Treatment Model Diagram

Training: AK Brief Intervention

• A web-based training to educate healthcare providers on the brief tobacco intervention, local and statewide resources, and Alaska’s Tobacco Quit Line

• AAR Brief Tobacco Intervention (Ask, Advise, Refer)

• Collaborative effort specific to Alaska

akbriefintervention.org

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Document: EHR

• Simple steps can be introduced effectively into the clinical workflow to support quitting– Document patient’s tobacco use– Document counseling and interventions provided– Document the referral

• Make it easy: use prompts for providers to follow, in as few clicks as possible

• Electronic referrals to the Quit Line can be integrated into the workflow

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Documentation in EHR Produces Positive Results

• Electronic health record-based interventions can lead to significant reduction in tobacco use

• Prompts for providers to Ask, Advise, Refer will improve cessation treatment outcomes

• With EHR, providers routinely reach high levels of identification and intervention (>80%)

• EHR Documentation helps increase reimbursement for cessation services

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Therapy Odds Ratio vs Placebo†

Nicotine gum 1.5

Nicotine patch 1.9

Nicotine inhaler 2.5

Nicotine nasal spray 2.7

Nicotine lozenge (2 mg/4 mg)‡ 1.96 / 2.76

Bupropion SR 2.1

Varenicline‡ 3.68* Table is adapted from multiple studies† All arms, including placebo, included behavioral counseling.‡ Continuous abstinence rates.

Pharmacotherapy and Counseling Combined Increases Success

Efficacy of Smoking Cessation Pharmacotherapies vs Placebo at 6 Months*

Evidence-Based Treatment Approaches for Tobacco

• FDA-approved medications– Medications to treat withdrawal symptoms– Options to match individual needs of patient

• Varenicline / Chantix• Buproprion / Wellbutrin• Nicotine Replacement Therapy (NRT)

– Gum– Patches– Lozenges

• Pharmacotherapies used in combination

Source: PHS Clinical Practice Guidelines, 2008 Update

Evidence-Based Treatment Approach

• Counseling and coaching programs– Tailored to the needs of the patient– Support to adjust to no longer smoking or chewing

• Education• Coping strategies• Support

– Multiple communication formats (person to person, telephone, texting/SMS, digital)

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More Payment Options for Cessation Services

• An Essential Health Benefit– The Affordable Care Act requires private insurance to

cover tobacco cessation treatment as of Oct. 2014– Medicaid reimburses for interventions provided by

qualified providers

• Alaska Division of Behavioral Health clarified Medicaid coverage for funded organizations– Behavioral Health specialists at all levels can provide

Medicaid-reimbursable cessation counseling

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MAKING CHANGE A REALITY: HOW YOUR ORGANIZATION CAN BENEFIT

The case for investing in health care systems change to address tobacco use and dependence

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Systems Change Complements Quality Improvement Efforts

Implementing systems for treating tobacco use can catalyze other improvements.• Works well with and reinforces the patient

centered medical home model• An opportunity for integrating primary and

behavioral health care• Works with quality improvement measures and

efforts already in place

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• Sites that achieve systems change experienced a 40% greater reduction in smoking prevalence within their patient population (13.6% reduction vs. 9.7% reduction)

• Quitting smoking can lower total health care costs within 2 years, and by 10%+ in 3 years

• Employee cessation program expenditures can be fully offset by health care savings within three years ($144 to $804 per smoker)

Systems Change Helps Patients, Staff, and the Bottom Line

CHCs THOs Hospitals0

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40

60

80

100

askadviserefer

How Are Alaska Organizations Doing? Baseline Survey (2012)

In Alaska, most medical professionals in the surveyed organizations are asking their patients about tobacco use, but more could be advising patients to quit and referring to cessation services.

43 * Survey results from Spring 2012

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CHCs THOs Hospital0

20

40

60

80

100

QAEHRs

Treatment quality assurance (QA) measures and electronic health records (EHRs) being used more, but there is opportunity to improve.

* Survey results from Spring 2012

How Are Alaska Organizations Doing? Baseline Survey (2012)

In Alaska, around half of organizations have comprehensive tobacco-free campus policies• 56% of Community Health Centers (CHCs)• 47% of Tribal Health Organizations (THOs)• 42% of Hospitals• Smoking and tobacco use by patients, staff, and

visitors are not allowed indoors or outdoors at all sites and at all times

Let’s make it 100%!45 * Survey results from Spring 2012

How Are Alaska Organizations Doing? Baseline Survey (2012)

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Making Change: Where to Start?• Make it easy

– for medical teams to ask, advise, and refer– to document and refer within a patient’s EHR– to prescribe the right medications – to refer to counseling

• Establish a change team in your organization• Conduct a return on investment (ROI) to determine the

value of providing in-house cessation for patients and staff• Integrate tobacco cessation into patients’ care plans• Provide cessation services and bill for reimbursements your

organization is entitled to• Look for local partners in primary care, behavioral

health to support systems change

The Mission 100 team can help you integrate clinical best practices into

your health system.

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Mission 100 ServicesInformational + Cessation Materials

Systems change manualFact sheetsCase studiesQuit Line materials

Cessation + Clinical Workflow Assistance

Ask, Advise, ReferDocument AARQuit Line Fax ReferralReturn on Investment AnalysesBilling & Reimbursement

Policy AssistanceTobacco-Free CampusPolicy Implementation & Enforcement

Provider Trainings Brief InterventionQuit Line + Fax ReferralBilling/ReimbursementMedications

Questions or comments?

Thank you!

www.mission100alaska.orgInsert presenter’s name and contact info (email and/or phone) for followup