How much can I save if I

quit smoking?

Packs 1 day 1 year 10 years

half $3.5 $1300 $13,000 1 $7 $2600 $26,000 2 $14 $5200 $52,000

Introduction & Background

Aim

Methods

Lessons Learned

Baseline Data and Results

Conclusions

IMPROVING SMOKING CESSATION IN

PRIMARY CAREMonica Khunger, Pete Spanos, Aniko Kukla, Michelle Slater, Joseph Graber, Alessandra Lyman PS & Nicole Mongilardi

Louis Stokes Cleveland VA Medical Center, Center of Excellence in Primary Care Education, Cleveland, OH

• Smoking remains leading preventable cause of

death in the US with only 1/3rd of patients using

available treatments.

• Behavioral support and advice from a clinic run by

smoking cessation specialists is effective in aiding

smoking cessation.

• Programs of support involving multiple contacts for

a period of four weeks or more given by specialists

enables, on average, about one in 20 attempts to

quit to succeed for six months or more that would

not otherwise have done.

• Prevent clinic data collected

from 1st July 2014 to 30th June

2016 from electronic medical

record (CPRS)

• We considered someone as a

smoker if either “health factor”

or ICD identified them as

“tobacco user”

• Total number of smokers in

primary care clinic panel: 1685

• LPN and residents surveys

performed

-Increase patient referral and patient

attendance to the PREVENT CLINIC

(multidisciplinary program for veterans for

smoking cessation) by 15 percent in 6

months

INTERVENTIONS PERFORMED:

• Education to residents about PREVENT clinic.

• Surveyed residents to identify possible

barriers for PREVENT clinic referral.

• Surveyed LPNs to identify frequency of

patients’smoking status.

• Surveyed LPNs to assess knowledge of

various VA resources for smoking cessation.

• “Costs of cigarettes” fliers displayed in clinic

and handed to patients at check in.

• Costs ofFliers about Same fliers handed by

receptionist upon check in of each

outpatient visit in addition to given by the

LPNs while taking vital signs and providing

immunizations.

• Discussion with providers in morning huddles

and discussion with LPN’s about smoking

cessation resources

References

• By using simple, low cost strategies i.e. fliers and informing the key stakeholders

about available resources we were able to increase the number of patients

scheduled to the smoking cessation clinic by more than 15% in six months.

Stead, L. F., Bergson, G., & Lancaster, T. (2008). Physician advice for smoking cessation. The Cochrane Library.

Sherman, S. E., Yano, E. M., Lanto, A. B., Simon, B. F., & Rubenstein, L. V. (2005). Smokers’ interest in quitting and services received: using practice information to plan

quality improvement and policy for smoking cessation. American Journal of Medical Quality, 20(1), 33-39.

Meredith, L. S., Yano, E. M., Hickey, S. C., & Sherman, S. E. (2005). Primary care provider attitudes are associated with smoking cessation counseling and referral. Medical

care, 43(9), 929-934.

Suls, J. M., Luger, T. M., Curry, S. J., Mermelstein, R. J., Sporer, A. K., & An, L. C. (2012). Efficacy of smoking-cessation interventions for young adults: a meta-analysis.

American journal of preventive medicine, 42(6), 655-662.

Anczak JD, Nogler RA. Tobacco Cessation in Primary Care: Maximizing Intervention Strategies. Clinical Medicine and Research. 2003;1(3):201-216.

• Involve stakeholders early

• Assign ownership of a task to an individual

• Continuously measure and monitor results to ensure the intervention is working

• Collect baseline data before choosing an intervention

• Be flexible with the interventions and the aim statement

• Continue to improve based on available data