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TRANSCRIPT
Increasing Access to Tobacco Cessation Services for PHA Residents by Establishing Referral
Systems between Quitlines and CHCs
Wednesday, March 11, 20203:00 – 4:30 PM ET
We’ll get started at 3:00 pm EDT (12:00 pm PDT)
To mute/unmute your line: *1For operator assistance: 0
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Agenda I. Welcome & Overview – Tasha Moses, MPA, NAQC
II. Smoke-Free Public Housing: Helping Smokers Quit Project Overview - Tasha Moses, MPA, NAQC
III. Importance of Referral Systems between Quitlines & CHCs - Tasha Moses, MPA, Program Manager, NAQC
IV. State Quitline Perspective – California - Sharon Cummins, PhD, Project Director, California Smokers’ Helpline
V. State Quitline Perspective – Pennsylvania - Sue McLain, MPH, Public Health Program Administrator, Pennsylvania
VI. Community Health Center (CHC) Perspective - Humberto Piñón, CHES, Health Educator, Curry Senior Center
VII. Opportunities for Collaborating with CHCs - Bob Burns, Project Director, National Center for Health in Public Housing
VIII. Questions and Discussion
Webinar Objectives By the end of this webinar, participants will be able to:
▪ Describe the Smoke Free Public Housing: Helping Smokers Quit Project
(SFPH:HSQ) and discuss outcomes achieved to date.
▪ Discuss the importance of establishing referral systems between Community
Health Centers (CHCs) and quitlines.
▪ Describe how 2 state quitlines collaborated with a CHCs in their state to
establish referral systems.
▪ Discuss resources available and describe opportunities for state quitlines to
collaborate with CHCs to implement referral systems.
Overview of Technology ▪ Please keep your phone on Mute during the presentation➢ *1 to MUTE or UNMUTE
▪ Mute the speakers on your computer and webinar portal
▪ DO NOT place your phone on hold
▪ Note the Chat function on the top right side of your screen
Poll Question #1
Which of the following best describes the organization you
represent?
• State Quitline
• Community Health Center (CHC)
• Public Housing Agency (PHA)
• Non-profit organization
• State health agency employee
• Other
SMOKE-FREE PUBLIC HOUSING: HELPING SMOKERS QUIT PROJECT
OVERVIEW
Tasha Moses, MPANAQC
Smoke-Free Public Housing: Helping Smokers Quit (SFPH: HSQ)▪ 2-year RWJF-funded project
▪ Partnership between 3 national organizations: ACS, SCLC and NAQC; and 5 state quitlines, PHAs and CHCs
▪ Goal: Reduce tobacco use among residents of public housing by increasing their demand for cessation services and their access to such services, thereby improving the overall health, well‐being and equity of public housing communities.
Importance of this Project
▪ High prevalence of smoking among public housing residents (38% compared to 15% for “all adults”).
▪ Smoking increases the risk of many diseases and premature death.
▪ Effective cessation services (counseling and FDA-approved meds) are available at no-cost through state quitlines and are covered by most commercial health plans and Medicaid.
▪ We can improve the health of public housing residents.
NAQC’s Role in the Project
Work with quitlines in the 5 pilot states to:
▪ Build partnerships with the state PHA and CHC;
▪ Increase the delivery of quitline services to PHA residents; and
▪ Coordinate with CHCs for delivery of cessation services to residents of PHAs (referral, triage).
▪ Disseminate the lessons learned to the broader community.
Project Key Outcomes
➢ Increased knowledge of quitlines and the services they offer
➢ Collaborative relationships established between all 5 state quitlines, CHCs,
PHAs and other entities (Primary Care Associations, etc.)
➢ Referral systems established between all 5 state quitlines and CHCs
➢ Resource directories developed for all 5 state quitlines
Resource Directory ➢ Connect PHA residents to additional
evidenced-based tobacco cessation
services.
➢ Serve as a template for other states to develop their own directory.
Resources in the Directory
Online/
Mobile
Description of Service
Contact Information
Service Type & Details
Resources Directory Format
Project Lessons Learned
▪ Many CHCs are unaware of the quitline and what it does.
▪ Look for willing collaborators.
▪ Look beyond the physician to provide the referral.
Key Elements that Facilitated Success▪ In-person project kick-off meeting. ➢ provided the foundation for the relationship with the CHCs ➢ served to springboard the collaborative work accomplished through the project.
▪ Access to subject matter experts and technical assistance provided through bi-weekly
ECHO (Extension for Community Healthcare Outcomes) sessions.➢ gain greater insight into tobacco cessation challenges from national, tobacco
cessation experts; obtain technical assistance to address the challenges through case studies; and gain a “boots on the ground” perspective of how tobacco use impacts people in real life.
▪ ACS’s state health systems representative as a convener/facilitator.➢ provided support and accountability
IMPORTANCE OF ESTABLISHING REFERRAL SYSTEMS BETWEEN QUITLINES AND
COMMUNITY HEALTH CENTERS
Tasha Moses, MPA
NAQC
Referrals received by quitlines, FY12 - FY18
171,379
184,358
198,811
184,525
213,013 211,774
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
220,000
240,000
Sum Total Referrals
FY12 FY13 FY15 FY16 FY17 FY18
n=50
n=47
n=47n=52
n=48
n=48
Referral Types offered by Quitlines
FAX EMAIL/ONLINE E-REFERRAL
Fax and online referral, FY13 - FY18*
100%
36%
100%
43%
100%
85%
100%
87%
100%
87%
0%
20%
40%
60%
80%
100%
120%
Faxed form Email or online
FY13 FY15 FY16 FY17 FY18
n=53
n=19
n=44
n=23
n=46
n=46n=53
*Data source: NAQC quitline profile
n=53 n=53 n=53
eReferral capacity among quitlines, FY17*45%
9%
43%
2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2017
Adopted In progress No capability Status unknown
n=24
n=6
n=23
n=5n=1
*Data source: 2016 Quitline Vendor eReferral Survey (2017 update)
Why are referral systems between quitlnesand CHCs important?▪ CHCs are well positioned to identify tobacco users
▪ Shared target population
▪ Provider recommendation can increase odds of of patient quitting
▪ Promotes and achieves health system change
Type of referrals available through participating state quitlines
Type of referral CA KY MO PA SC
Fax referral form ✔️ ✔️ ✔️ ✔️ ✔️
Email or online referral ✔️ ✔️ ✔️ ✔️
Electronic Health Record (EHR) –transmitted directly from an EHR to
the quitline ✔️ ✔️ ✔️ ✔️
Types of referral established between state quitlines and CHCs
State Quitline CHC Referral Type
California Curry Senior Center Web-based
Kentucky Shawnee Christian Health Center Web-based
Missouri Affinia Healthcare Fax/Email Referral
Pennsylvania Lancaster Health Center eReferral
South Carolina Hope Health Center Fax Referral
www.ucquits.com
Sharon Cummins, PhD California Smokers’ Helpline
State Perspective – California
www.ucquits.com
Project Participation
▪ Asked by our funding agency
▪ Call volume is decreasing
▪ Outreach/promotion
▪ Current thinking includes:• Go to the smoker
• Develop partnerships/champions
• Ask, Advise, Refer
• Use technology to embed into workflow
www.ucquits.com
Working with Curry Senior Center
▪ Dedicated to their seniors
▪ Comprehensive services
▪ Identification of gaps in services—what did we have to offer?
www.ucquits.com
Role of the Quitline in Cessation
▪ Provide cessation services
▪ Share resources
▪ Understand workflow and identify gaps in service
▪ Implement direct referral
▪ Provide data
www.ucquits.com
Services and Resources
▪ Telephone Counseling• 1-800-NOBUTTS, 1-800-QUIT-NOW• 1-844-8-NOVAPE• 1-800-45-NO-FUME, 1-855-DEJELO-YA• Asian Smokers’ Quitline
▪ Additional services for consumers: Nobutts.org, Novapes.org• Chat• Texting• Mobile apps• Alexa
▪ Additional services for healthcare and others: chat, referral options, trainings, fact sheets
www.ucquits.com
Services and Resources
▪ Telephone Counseling• 1-800-NOBUTTS, 1-800-QUIT-NOW• 1-844-8-NOVAPE• 1-800-45-NO-FUME, 1-855-DEJELO-YA• Asian Smokers’ Quitline
▪ Additional services for consumers: Nobutts.org, Novapes.org• Chat• Texting• Mobile apps• Alexa
▪ Additional services for healthcare and others: chat, referral options,trainings, fact sheets
www.ucquits.com
Referrals
▪ Peer-to-Peer--$$• Large health systems• Sophisticated infrastructure
▪ DIRECT Messaging--$• Health systems that already use it
▪ Web-based—free!• Small clinics• Community based organizations• Able to trace back to the referring organization
▪ Client completes intake directly online
www.ucquits.com
Results and Considerations
▪ Six referrals
▪ Volume—population, motivation
▪ Sustainability—turnover, other priorities,
▪ Contact • Building relationships to develop advocates
• Providing data
• Needs assessment and providing needed resources
▪ Feedback
State Perspective -
Pennsylvania Smoke Free Public Housing: Helping Smokers Quit
2013 - Pennsylvania Smoke Free Housing
initiative started
Goal - increase number of people newly protected by
smokefree policies in multi-unit housing
❑ 125,237 individuals impacted by smoke free
multi-unit housing policies in both public and
private housing settings (by 2019)
Smoke Free Housing: Helping Smokers
Quit Project
Lancaster Community Health Center
Lancaster Housing Authority
Health Promotion Council in Southeast PA
PA Free Quitline
Events – Lancaster Housing Authority
➢ Housing resident survey
➢ Block party – Lancaster Housing Authority - blood
pressure screening and smoking cessation materials
➢ Great American Smokeout event at Lancaster Housing
Pennsylvania Free Quitline
“Do you currently live in public housing
(sometimes called subsidized housing)?”
16,326 users requested services last year
Proportion of callers living in public housing: 15.3%
HOUSING QUESTION:
PA Free Quitline Callers
Callers living in public housing are significantly less likely
to remain quit at 6 month follow-up than those living
elsewhere (26.4% vs. 32.3%)
Community Health Center
➢ # admissions to Lancaster CHC 2018 – 18,971
➢ Offer primary care, dental, behavioral health services
➢ For non-emergent illnesses and conditions
➢ Target market - low socio-economic residents in area
Community Health Center Issues
➢ Ask, Advise, Refer (AAR) not being routinely used with patients, not on providers' minds
➢ No visual aids in use to remind providers of AAR
➢ Center healthcare staff unaware of their potential role in AAR
➢ Center managers not aware of Pa Free Quitline and other resources
Community Health Center
Steps to Resolution
➢ Revise workflow with patient to include AAR
➢ Provide consistent visuals to remind center staff and
providers of AAR with every adult patient
Screen is part of EMR (MA completes)
Positive screen results in addition of ICD10 Codes (tobacco use/tobacco AAR)
to front sheet of EMR
Reminder appears for provider to address tobacco use
Community Health Center
Steps to Resolution
Physician prompt appears in EMR with available resources:
e.g., Pa Free Quitline wallet cards, LGH in-person
counseling text msg
NRT available for immediate start if desired
Cessation-focused posters in every treatment
room
Community Health Center
Steps to Resolution
➢ Training planned to meet provider and center staff
needs❑ AAR process
❑ Tobacco cessation process
❑ Use of NRT (short- and long-acting), bupropion
❑ Additions to EMR, prompts
Community Health Center
Steps to ResolutionEvaluation and Implementation of e-Referral
Explanation of e-Referral & costs by DOH and NJH
(vendor)
Exchange of information about IT requirements
NJH and CHC set up software for e-Referral
Test runs
Training providers and center staff to use e-
Referral prompt and process
Community Health Center
Next Steps
Launch e-Referral
Arrange for regular data reports from Quitline
Use quantitative (QL data) and qualitative (feedback) info
for quality improvement of processes
Thank you!
Lyn Becker, [email protected], PA Department of Health
Cachet Adams, [email protected], PA Department of Health
Thank you!
Lyn Becker, [email protected], PA Department of Health
Cachet Adams, [email protected], PA Department of Health
Community Health Center Perspective
Humberto Piñón, CHES
Curry Senior Center
Location: Tenderloin District, San Francisco, CA
Mission: Our mission is to promote wellness, dignity & independence for seniors.
Curry Senior Center is a multi-purpose center that provides a wide spectrum of elderly health care programs and services to senior residents in San Francisco.
Population: Seniors 55+
Services: Primary Care, Case Management, Housing Services, Substance Use Therapy, Health Education, food programs, cultural programs and wellness programs all available for people 55+ and free of charge.
Opportunities for Collaborating with CHCs
Bob Burns National Center for Health in Public Housing
Resident Health and Tobacco Use in Public Housing:
Health Centers, Quitlines and Other Resources for Tobacco Cessa on
March 11, 2020.
National Center for Health in Public Housing
This presentation is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $608,000 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
Training and Technical
Assistance
Research and Evalua on
Outreach and Collabora on
Increase access, quality of health care, and improve health outcomes
National Center for Health in Public Housing www. nchph.org
The National Center for Health in Public Housing (NCHPH), a project of North American Management, is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $608,000 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
Agenda
• Resident Health and Tobacco Use in Public Housing
• Smoke Free Public Housing
• Health Centers and Tobacco Cessation Services including Quitlines
• NCHPH and Other Great Resources
Public Housing Demographics
5
1.8 million residents
2.1 persons/household
38% children 59% female
55% less than high school diploma
83.2% below federal poverty
17% seniors
≥ 62
21% of households include a disabled
member
A Health Picture of HUD Assisted Adults 2006-2012*
Adults that receive assistance from HUD have higher rates ofchronic health condi ons and are greater u lizers of healthcare than the general popula on.
o35.8% are in fair or poor health vs. 13.8% of other adults
o71% are overweight or obese vs. 64% of other adults
o61% have a disability vs. 35.4% of other adults
o17.6% have diabetes vs. 9.5% of other adults
*Updated edi on expected in Summer 2020.
6
A Health Picture of HUD Assisted Adults 2006-2012*
Adults that receive assistance from HUD have higher rates ofchronic health conditions and are greater utilizers of health carethan the general population.
o 39.3% with distress with mental hardship vs. 21.4% of otheradults
o 11.6% have serious psychological distress vs. 3.7% of otheradults
--In the U.S., 40% of all cigarettes consumed by adults areconsumed by adults with some form of Mental Illness. (CDC)
*Updated edition expected in Summer 2020.
7
Cigarette Smoking: National Vs. Housing Data
8
Source: Cigare e smoking and adverse health outcomes among adults receiving federal housing assistance - HUD
Cigarette Smoking – HUD Programs
28
29
30
31
32
33
34
35
36
Public Housing Housing ChoiceVoucher
Mult i Family
33.6
35.3
30.913.7
86.3
Cigarette Smoking U.S. Adults Aged 18 Years and Older in 2018
Percentage of Smokers
Percentage of Non-Smokers
Source: Centers for Disease Control and Preven on
Tobacco-Related Illnesses Exacerbated by Secondhand Smoke in HUD Housing-Assisted Programs
o13.6% have COPD vs. 6.3% of other adults
o16.3% have asthma vs. 8.7% of other adults
o33.5% are current smokers vs. 22% of other adults
Source: A Health Picture of HUD-Assisted Adults 2006-2012
9
Smoke-Free Public Housing• On December 5, 2016, The U.S. Department
of Housing and Urban Development (HUD) published a final rule requiring all Public Housing Agencies (PHAs) administering low-income, conven onal public housing to ini ate a smoke-free policy.
• The Rule was effec ve on February 3, 2017 with an 18-month implementa on period.
• Effec ve August 1, 2018 Public Housing was Smoke-Free Na onwide
Public Housing Primary Care Health Centers
11
Health Centers near Public Housing
12
• 1,400 Federally Qualified Health Centers (FQHC) =29 million
• 11,000 Clinical Sites
• 356 FQHCs In or Accessible to Public Housing = 4.4 million patients
• 107 Public Housing Primary Care (PHPC) =817,123 patients
www.nchph.org
Collabora on between Health Centers and Public Housing Authori es
13Source: NCHPH 2016 Needs Assessment
72%
78%
14
2018 UDS Tobacco Data
Source: 2018 UDS Data
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Asthma Diabetes mellitus Heart disease (selected) Tobacco use disorder Smoke and tobacco usecessation counseling
Pa ents with Tobacco-Related Illnesses/ Health Condi ons Exacerbated by Secondhand Smoke and Tobacco Use in PHPCs, 2018
15
74.47%
93.62%
82.98%78.72%
95.74%
87.23%
23.40%
4.26%
12.77% 14.89%
2.13% 2.13%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
On-site smoking cessation Referrals to smokingcessation counseling
Quit line number orinformation about other
resources
Nicotine replacementtherapy (e.g. patches,
gum, lozenges)
Quit smoking information(e.g. booklet, brochure,
video, etc.)
Suggestions to contactprimary care provider
Smoking Cessation Services Offered at Health Centers Located in or Accessible to Public Housing
Yes No
Source: NCHPH 2016 Needs Assessment
16
74.47%
93.62%
82.98%78.72%
95.74%
87.23%
23.40%
4.26%
12.77% 14.89%
2.13% 2.13%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
On-site smoking cessation Referrals to smokingcessation counseling
Quit line number orinformation about other
resources
Nicotine replacementtherapy (e.g. patches,
gum, lozenges)
Quit smoking information(e.g. booklet, brochure,
video, etc.)
Suggestions to contactprimary care provider
Smoking Cessation Services Offered at Health Centers Located in or Accessible to Public Housing
Yes No
Source: NCHPH 2016 Needs Assessment
Enhancing Quitline Use
• Promote Quitlines as more than a helpline, e.g., free, a tailored quit plan, counseling and medications (depending on the state)
• Clarify the limits of a Quitline, e.g., duration of services
• Use Electronic Referrals from provider (EHR and Fax)
• Coordinate initiatives with Health Centers
• Coordinate initiatives with Primary Care Associations
• Collaboration between Quitlines, DPHs, PHAs, FQHCs and PCAs
General Recommenda ons on Smoke Free and Tobacco Cessa on
• Establish Reciprocal Partnerships, e.g., memberships on boards, advisory groups and relevant task forces
• Engage with the community
• Culturally appropriate health education materials, e.g., CDC Tips• Case Management- ID Needs & monitor progress w/cost effective staffing
• Leverage resources, Federal, State, local government & non-profits
• National Resources: NAQC, CDC, ACS, SCLC, ALA
• Electronic Referrals to Quitlines (Fax and EHR)
• Expand smoking cessation services
• MAT/NRT + Counseling
• Healthy Alternative Activities• Create incentives for participation
18
NCHPH Ac vi es on Smoke-Free Public Housing
Publications: Fact Sheets and
BriefsWebinars
Learning Collaborative
National Training
SymposiumWidget Collaborations
NCHPH Smoking Cessation Resources
NCHPH.ORG, website:
o Abstracts, Best Practices, Factsheets
o Smoke-free Widget-Links to partners’ information
o List of Community Health Centers
o List of Primary Care Associations
o Maps of Health Centers and PHAs
o Webinars and Training Symposia
o Health Center Locator: BPHC.HRSA.GOV
o Smoking Cessation Learning Collaborative–Program Year July 2020 – June 2021
20
• When? June 18 – 19, 2020
• Symposium Registration, Call for Abstracts and Posters, and sponsorship opportunities are now available for our 2020 Symposium.
• Early-bird registration March 31, 2020
• For more information visit:
NCHPH.org
21
NCHPH Smoking Resources
https://nchph.org/smoking-cessation-resources/
Smoking Cessation Resources
Tips From Former Smokers ®
US Department of Housing and Urban Development
National Center for Health in Public Housing
UCSF Smoking Cessation Leadership Center
American Lung Association
American Cancer Society
North American Quitline Consortium
23
24
25
Project ECHO SFPH: Helping Smokers Quit
https://www.youtube.com/channel/UCZJkiYd7njqOYoFz_VyUa9Q/videos?reload=9
Website:
www.healthcenterinfo.org
CDC Tips Campaign
3/11/20 29
Download Center Media Campaign Resource Center
www.plowsharegroup.com/cdc ps www.cdc.gov/tobacco/MCRC
Broadcast-quality Tips ads and other tobacco countermarke ng ads for paid
campaigns
Free materials including low-resolution TV ads; radio, digital, print, and out-of-home ads; and public service announcements
National Center for Health in Public Housing
• Bob Burns, MPA, [email protected]
• Jose Leon, MD, MPH, Chief Medical [email protected]
• Saqi Cho, DrPH, Policy, Research and Health Promo on [email protected]
• Chantel Moore, MA Communica ons [email protected]
• Fide Pineda Sandoval, CHES, Health Research [email protected]
Please contact our team for Training and Technical Support.
31
QUESTIONS & DISCUSSION
Poll Question #2
What did you learn from today’s webinar?
▪ Outcomes from the Smoke-Free Public Housing: Helping Smoker’s Quit project
▪ The importance of establishing referral systems between quitlines and CHCs
▪ Information for how state quitlines were able to collaborate with CHCs
▪ Opportunities for state quitlines to collaborate with CHCs
Poll Question #3What actions are you likely to take as a result of today’s webinar?
▪ Identify CHCs in my state to engage
▪ Contact my state quitline to learn more about the referral systems offered
▪ Assess my clinic's tobacco cessation referral protocol
▪ Access some of the resources discussed during the webinar
▪ Other action(s)
Poll Question #4
What additional information are you interested in receiving after
the webinar?
▪ More information about state quitlines
▪ More information about CHCs
▪ More information about NAQC
▪ Other information
▪ No information
Presenter’s Contact Information ➢ Tasha Moses, MPA - [email protected]
➢ Sharon Cummins, PhD - [email protected]
➢ Lyn Becker, MBA, RMA - [email protected]
➢ Sue McLain, MPH - [email protected]
➢ Humberto Piñón, CHES - [email protected]
➢ Bob Burns - [email protected]
REMINDERS:
▪ Please complete the webinar evaluation!
▪ Slide deck and webinar recording will be available.
▪ Visit www.naquitline.org to view the resource directories and other project related resources.
