A Clinical Intervention Program for Tobacco Prevention and Cessation Detroit, Michigan

1. A Clinical Intervention Program for Tobacco Prevention and Cessation Detroit, Michigan

2. VODI’s Goal Research, Design, and Implement a comprehensive clinical intervention program for tobacco cessation.

3. What is VODI? A Collaborative Partnership • Henry Ford Health System • St. John Health • The Detroit Medical Center • The Detroit Department of Health • Federally Qualified Health Centers • Political, Faith-based, and human service organizations • Part of the W.K. Kellogg Community Voices Initiative

4. What does VODI do? • VODI provides free or low-cost health services to the uninsured and underserved • VODI focuses on primary care, pharmacy, lab, dental, care management, and pharmacy services • VODI is the “medical home” for low-income, uninsured residents of Detroit

5. A bit of background… •  Detroit is 83% African American • There is no “public health” hospital • There are approximately 180,000 uninsured people in Detroit and the number served by VODI is 20,000 • Detroit has 3 major universities, 2 dental schools and a community college system.

6. Who are VODI patients? • live in Detroit • cannot qualify for Medicaid or other public insurance programs • are between the ages of 18 and 64 • fall below 250% of the federal poverty level guidelines (average monthly pay rate is under $1000). • the average age of a VODI client is 39 years old. • Over half of VODI clients are employed.

7. The VODI Vision • Time • Energy • Commitment • Improve quality…reduce costs

8. VODI’s Tobacco Cessation Program • CME • Health Education Kiosks • Nicotine replacement and/or pharmacotherapy • Academic Detailing • Tobacco Cessation Counseling

9. Continuing Medical Education:“Oral Health & Tobacco Cessation in a Primary Care Setting” • CD-ROM: University of Michigan – School of Dentistry * 2 Websites • Accreditation: Wayne State University and the Detroit Medical Center * 4 CME credits

10. Development of the CME • Content (provider focus groups) • Technical Support • Medical Review • Media Consultants • Accreditation

11. Continuing Medical Education • Identify the users • Determine readiness to quit • Tailor counseling based on readiness

12. CME Evaluation • Pre-test and Post-test questionnaires • 6-month follow-up survey More than 100 providers have been trained 100 more in the next 2-3 months

13. CME Results – ScoresPre- and Post-Session Questionnaires Pretest: During the last week, how many patients have you counseled to quit smoking/using tobacco? Mean number of patients: 7 During the last week, how many times have you recommended NRT or Zyban to assist them? Mean number:2 Follow-up: Question 1: Mean number of patients: 6 Question 2: Mean number 3

14. CME 6-Month Follow-up • Did the CME contain what they needed to counsel patients? • Could they counsel based on readiness to quit after the CME? • Did they find the information useful?

15. Health Education Kiosks • Used by over 9000 individuals • Provides information on tobacco use and tips on quitting smoking. • Gives us information about smoking rates and attitudes toward smoking among clinic patients.

16. The next steps to a Comprehensive Tobacco Cessation Program • Free Nicotine Replacement Therapy and/or Pharmacotherapy • Academic Detailing • Tobacco cessation counseling and support programs

17. Academic Detailing Various levels of interaction/approvals • Provider • Administration • Medical Director • Health Care Systems

18. Academic Detailing • Assessments • Clinic Specific Plans • Form Revisions • Training • Follow-up/Program Maintenance

19. Assessments What systems are in place? Do they: • designate tobacco use at each visit? • assess patient’s readiness to quit? • have any health education materials? • document advice given? • have any referral services in place?

20. Clinic Specific Plans • Health Education Materials • Videos, posters, banners • Fliers/magnets for referrals to counseling and/or Quit Line • ICD-9 Codes • NRT/Zyban Cheat Cards • Monthly newsletters • Dinner meetings/seminars • Quit smoking days at the clinics

21. Form Revisions 1. Intake/History Forms2. Vital Signs (SVS)3. Progress/Intervention Notes

22. Training • Let staff know what has been implemented and work with them for as long as it takes • Present data from CME pre-test,post-test and follow-up • Present data from the kiosks • Teach use of educational materials as tools for talking to patients • Present research based on their clinic demographics • Stress the importance of using the prescriptions properly • Teach them how to refer patients with our tools

23. Follow-up/Program Maintenance • Stay in close contact with the clinics • Assign Champions in each clinic

24. Program Evaluation Tools • ICD-9 Code 305.1: Tobacco Use Disorder • Nicotine Replacement Prescriptions • Medical Chart Audits • Counseling/Quit Line Referrals

25. Sustainability • Potential Grant Funding • Development of a Business Plan to offer this program to HMO’s and private practices • Providing them with materials that can be copied or ordered at no costM • Implementing permanent documentation through forms

26. Contact Breaking Free Breaking Free Gayle Walters Phone: 517-546-2169 Email: gayle@creativecatalyst.com VODI Tobacco Use Reduction Project Deirdre Shires Phone: 313-832-4246 Email: dshires@med.wayne.edu CME Program: http://oralhealth.dent.umich.edu/VODI/html/00/about.html