cancer and heart disease, a case for working collaboratively to reduce tobacco use
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DESCRIPTIONCancer and Heart Disease, A Case for Working Collaboratively to Reduce Tobacco Use. Sandra Villalaz, RN, MPH, CHES Community Manager for Health Initiatives Central Texas Region, American Cancer Society. - PowerPoint PPT Presentation
Cancer and Heart Disease,A Case for Working Collaboratively to Reduce Tobacco UseSandra Villalaz, RN, MPH, CHESCommunity Manager for Health InitiativesCentral Texas Region,American Cancer Society
American Cancer Society MissionThe American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service.
ObjectivesDescribe one health care system level initiative to reduce tobacco use among patients.Identify three stakeholders critical to creating system level change and why.List two best practices and at least three community level resources available to assist in client smoking cessation attempts.
ConcernHealthy People 2010 goal to reduce tobacco use to 12 % not met. Actually we only met this goal for population 65 and older. American Cancer Society Goal for 2015 is the same.
The ProblemSmoking damages nearly every cell in your body. It can cause:CancersCOPDHeart DiseaseCV DiseaseGI ulcers/periodontal diseaseReproductive effectsEye disorders
Richard Carmona, Surgeon General of the US, Surgeon General Report, May 2004
Case Study and Stakeholders
The ChallengeSeized the opportunityMeeting with Austin Heart, PA Chief Operating OfficerPresented the challengeAsked what protocol was used for tobacco usersPrepared for the meeting
Tobacco Use and Heart Disease Statistics
As many as 30 percent of all deaths in the United States each year from heart attack are attributable to cigarette smoking (2)
Smoking-caused heart disease results in more deaths per year than smoking-caused lung cancer (4)
Tobacco use increases blood pressure and risk of stroke (1)
Women who smoke and use oral contraceptives greatly increase their risk of heart attack and stroke (4)
Smokers risk of a heart attack is two to four times greater than that of non-smokers (3)
1. American Heart Association, Inc., Cigarette Smoking and Cardiovascular Disease, July 18, 2005American Heart Association, Inc., Circulation, 1997; 96:3243-3247, Cigarette Smoking, Cardiovascular Disease, and Stroke A Statement for Healthcare Professionals From the American Heart Association, 1997 American Heart Association, Inc., Risk Factors and Coronary Heart Disease, July 18, 2005 U. S. Department of Health and Human Services, State Cardiovascular Disease Highlights, 1997, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1997
Austin Heart, PA 47 physicians provide care at 13 Central Texas office locations 8 countiescomprehensive range of services include prevention, general cardiology, vascular care, electrophysiology, and interventional cardiovascular services.
Article from Austin Heart Newsletter Feb 2009Smoking Remains the No 1 Cause of Preventable Death in the United States
Did you know that cigarette smokers are two to four timesmore likely to develop coronary heart disease than nonsmokers.Smokers are also more than 10 times as likely asnonsmokers to develop peripheral artery disease. After oneyear off of cigarettes the excess risk of coronary heartdisease caused by smoking is reduced by half. 15 yearsafter quitting, the risk is similar to that for people who have never smoked.
The MeetingResponded with information and orientation to service after learning about the practiceMet with Medical DirectorOffered educational materials and briefing on American Cancer Society Quitline .Offered Professional Education
Healthcare Professional EdProvided Provider and Nursing education as well as patient materials for 13 locations.Involved appropriate level of professionals
Tobacco half the problemOnly 70% of primary care physicians ask their patients if they use tobacco.Only 40% take action.
Providing Appropriate Tobacco Cessation Assistance is Important70% of smokers want to quit.93% of smokers who try to quit resume regular smoking within one year.Five to seven attempts are usually required to succeed.
CDC Recommendations Tobacco dependence is a chronic condition that requires repeated interventionsEvery patient should be offered a treatmentPatients willing to try to quit-should be offered effective treatmentsPatients unwilling to try to quit-should be offered a brief intervention designed to increase their motivation
Effective Tobacco Dependence InterventionsFiore MC, Bailey, Cohen SJ, et. al. Treating Tobacco Use and Dependence. Rockville, MD: US Department of Health and Human Services. Public Health Service. October 2008. MMWR/Recommendations and Reports: November 10,2000/Vol. 49/No.RR-12. A report on findings.American Journal of Preventive Medicine.AM J Prev Med 2001:20 (2S); 16-66. A report on findings and evidence.
Austin Heart, PAPhysicians will address smoking and quitting.Physicians advice to quit is an important motivator.Nurses and office staff will answer questions, help with resources and encourage patients.Patients can make an appointment with physician for smoking cessation support and resources.Insurance provides payment to physicians for smoking cessation interventions.All personnel are responsible for encouraging and promoting a healthy lifestyle.
Changes reported2007 we had 4 physicians counsel 73 patients.2008 we had 4 physicians counsel 96 patients.2009 we had 36 physicians counsel 603 patients
Good News and Not such Good NewsDocument in the EMR patients smoking statusDocumented what counseling and support services were provided. Documented the appropriate diagnosis codes for tobacco abuse.BUT have not tracked if patients have actually stopped.
Best Practices and Resources
The Stages of ChangePre-contemplation: At this stage, the tobacco user is not thinking seriously about quitting right now. Contemplation: The tobacco user is actively thinking about quitting but is not quite ready to make a serious attempt yet.Preparation: Tobacco users in the preparation stage seriously intend to quit in the next month and often have tried to quit in the past 12 months. They usually have a plan. Action: This is the first 6 months when the user is actively quitting. Maintenance: This is the period of 6 months to 5 years after quitting when the ex-user is aware of the danger of relapse and take steps to avoid it.
5 AsAsk systematically identify all tobacco users at every visitAdvise-strongly urge tobacco users to quit with each visitAssess-determine willingness to make a quit attempt (within 30 days)Assist-aid patient in quittingArrange-schedule a follow up contact
5 Rs for those unwilling to quitRelevance-encourage pt to identify personal reason to quitRisks-ask pt to list negative consequences of smokingRewards-list potential benefits of quittingRoadblocks-identify barriersRepetition-repeat with each visit
Provider Reminder SystemsWhen:Patients who use tobacco are identified; Providers receive information to help them help their patients understand the risks and dangers Results in:Delivery of advice to quit by providersNumber of patients who do quit
You are an invaluable resource. Patients are more likely to quit successfully with the nurses support. (Good, Frazier, Wetta-Hall, Ablah, & Molgaard, 2004) If you dont mention it to your patients, they wont see it as important. Nurses are a trusted professional. We are failing our patients if we dont offer smoking cessation help. (Roberts, 2002)
Common BarriersPatients perceived or actual lack of interest or motivationLack of time and skillLack of knowledge and resourcesThought that it is an invasion of patient privacyNegative message may scare patients away.
(Good, et al, 2004)
Behavioral Interventions & 5 month Quit RatesSelf-help: 12.3%Proactive telephone counseling: 13.1%Group counseling: 13.9%Individual counseling: 16.8%The American Cancer Societys Quitline has a 1 year quit rate of 36%.The addition of pharmacologic agents have significantly improved success rates.
Hopkins, David, et al. Reviews of Evidence Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke, 2001. Am J Prev Med 2001;20(2):16-66.
ACS Quit For LifeIt only takes 30 seconds to refer a patient to a toll-free tobacco-cessation quitline.Quitlines are staffed by trained cessation experts who tailor a plan and advice for each caller.Calling a quitline can increase a smokers chance of successfully quitting.
Ethical ConsiderationsScreeningAsk at each visitEfficacious TreatmentRecommending Smoking CessationCounselingGroup, Individual or Phone
ACS Community ResourcesClientACS Quit For Life - a quitline In Texas: 1-877-YES-QUIT (877-937-7848)Pamphlets to provide informationSpanish/ EnglishWallet card-Spanish/English American Cancer Societywww.cancer.org1-800-ACS-2345American Cancer Society Fresh Start
Community ResourcesProfessionalQuick Guide to Helping Tobacco Users-Toolkit(5As and 5Rs cards for exam rooms) pdf ava