OHIO QUITS OUTREACH

1. OHIO QUITS OUTREACH DEBORAH H. JORDAN, Health Improvement Project Specialist Hospital Council of Northwest Ohio

2. PURPOSEOF TRAINING • To inform you about the Ohio Tobacco Quit Line: - Background - Benefits - How it works • How to become an Ohio Quit Site: - What it is - Criteria - Next steps

3. National Jewish Medical and Research CenterDenver, Colorado

4. Intake Volume TOTAL 58,311

5. DEMOGRAPHICS OF CALLERS • Males: 36% Females: 51% • 25-30%of callers are 45 – 54 years of age • 40-50% of recent callers are single • High school graduate • 55-75% White/Caucasian

6. RESOURCE FOR TOBACCO USERSAND NON-USERS • Nicotine dependence • Treatment options • Dangers of environmental tobacco smoke • Other tobacco related information

7. GOAL : CESSATION COUNSELING • Assessment • Use of pharmacotherapy • Counseling & advice

8. BENEFIT: Simple no cost point of access • Assessment of readiness to quit • Use of pharmacotherapy • Counseling and advice • Support materials • Referrals to community-based service • Collaboration with local health care providers

9. BENEFIT: Nicotine Replacement Therapy (NRT) • Insurers and/or large employers split cost of nicotine patches with Ohio Tobacco Use Prevention and Control Foundation • Callers get a chance to try 4-8 weeks of NRT patches, a savings of approximately $200

10. BENEFIT: Insurance/Employer NRT Partners INSURERS: • SummaCare • Medical Mutual of Ohio • Paramount Care • CareSource Employers include: • School Employees Retirement System of Ohio • Ohio Public Employees • Retirement System • ABX Air • Mentor Public Schools • Humility of Mary Health Systems • L’Oreal • Goodyear • Smith Dairy • PAC National

11. MEDICAID NRT COVERAGE • Nicorette gum • Commit lozenge • Nicoderm patches • Generic nicotine patches • Nicotrol inhalers • Zyban

12. NRT for the Uninsured

13. HOW DOES THE QUIT LINE WORK? .

14. Clinical Practice Guideline THE 5 A’s______ ASK about tobacco use ADVISE all users to quit ASSESS willingness to make a quit attempt ASSIST in quit attempt ARRANGE for follow-up

15. The Quit Line’s Three “A’s” and an “R” • Ask if your patient uses tobacco • Advise that person to quit • Assess their readiness to quit • Refer the patient to the Ohio Tobacco Quit Line

16. INTAKE CALL • Quit line will call tobacco user within 24 – 48 hours upon receiving Fax Referral form • Demographic information • Purpose of call • Set up counselor call

17. FIRST CALL • Determine tobacco use status • Commend decision to quit • Establish rapport • Collect information regarding the participant’s individual smoking history • Provide education about the nature of nicotine addiction • Provide information and recommend the use of pharmaceuticals (order NRT if qualified) • Address and validate the participant’s concerns about quitting • Set a Quit Date with the participant • Provide instructions about follow-up for the next call

18. PREPARE CALL • · Discuss NRT choice – if appropriate • · Discuss use of these medications • · Help the tobacco user identify difficult situations • · Discuss coping mechanisms for tough times • · Discuss the symptoms of withdrawal and ways to lessen severity • · Discuss cravings and strategies to deal with cravings • · Discuss small behavior changes leading up to the Quit Date • · Provide instructions about what to do before the Quit Date

19. SUPPORT CALL • Determine user’s quit status and conduct appropriate call based on status (if still using tobacco, perform relapse call) • Assess physical state and problem-solving strategies for coping with the physical symptoms of withdrawal • Assess emotional state and problem-solving strategies for coping with emotional distress • Discuss most difficult situation to date and assess implementation of coping strategies • Discuss use of or need for NRT and encourage follow up with physician • Discuss future difficult situations and how to plan strategies to cope • Commend any successes to boost confidence • Reassess motivation and provide encouragement

20. RELAPSE CALL(when needed) • Discuss reasons for not quitting on Quit Date • Discuss situation(s) that lead to relapse • Remind the participant that a relapse does not represent a character weakness; it simply speaks to the addictive nature of nicotine. • Discuss a new Quit Date • Discuss preparations for the new Quit Date

21. HOW TO REFER TO QUIT LINE • ONLY refer patients who are READY to quit. • Fill out ALL referral forms CORRECTLY.

22. Required before Fax Referral • 3As + R • Ask • Ask patient about tobacco use status • Advise • Provide clear, strong advice to quit with personalized messages about the impact of tobacco use • Assess • Assess the willingness of the patient to make a quit attempt within the next 30 days • Refer • Fax in a signed referral form with all required information

23. WHEN TO REFER… • Do you intend to quit using tobacco within the next 30 days? • If you have already quit would you like support at this time?

24. ONLINE SUPPORT & RESOURCES For quit line resources and writeable forms, go to www.ohioquits.com

25. Fax Referral Form

26. Fax Referral Tracking Grantees must provide specific information in order to receive outcome data from the Quit Line. • TUPCF Grantee ID : Outreach • Referring Provider Information

27. Fax Referral Form TUPCF Grantee ID

28. Fax Referral Form Referring Provider

29. Necessary Signatures • Physician MUST sign for patients to receive NRT. • Patient MUST sign to give consent for referral to be sent.

30. WHAT IS A QUIT SITE? Designation given by the OHA Foundation for Healthy Communities to hospitals dedicated to • integrating the 3A’s and R into their Clinical Practice Guideline protocol for tobacco use and dependence • referring patients, who express a readiness to quit, to the Ohio Tobacco Quit Line.

31. OHIO QUIT SITE CRITERIA Ohio hospitals will be designated “Ohio Quit Sites” after completing the following…

32. 1. Attend the entire ‘Get in Line with the Tobacco Treatment Clinical Practice Guideline’ training and complete the training evaluation tools. 2. Identify an Ohio Quit Site Coordinator:: - main point of contact & lead effort -sign the letter of the agreement

33. 3.Implement 3 A’s and R

34. 4. SUBMIT IMPLEMENTATION PLAN Form provided. This form is due by June 23, 2006 in order to be eligible for the cash incentive.

35. 5. Participate in an evaluation • Complete 1 or 2 surveys • Participate in a brief telephone interview

36. 6. Commitment to Ohio Quit Site Commit to be an Ohio Quit Site for 12 months from date of signature on letter of agreement

37. NEXT STEPS… • BEFORE you leave training, complete the post survey • Indicate interest in becoming a Quit Site

38. BACK AT THE HOSPITAL… • Share the training information with appropriate staff • Determine feasibility • Commit to criteria

39. FOLLOW UP CALL FROM OHA… • OHA will contact all institutions that express an interest in becoming a Quit Site • Confirm interest in Quit Site • Review letter of agreement • Discuss hospital plan • Discuss use of incentive • Answer questions

40. LETTER OF AGREEMENT • Identify Coordinator • Describe Quit Site process that hospital will use to integrate intervention and referral • Explain how incentive will be used

41. CONDUCT INTERNAL EDUCATION on integration of 3A’s and R process/fax referral into hospital protocols • Identify tobacco users • Identify patients readiness to quit • Follow fax referral form guidelines • Fax form to Quit Line

42. CONTINUED SUPPORT… • OHA • Hospital Council of NW Ohio • Statewide Task Force • Open Forum Listserve

43. CONTACTS... • For information on the Letter of Agreement : Susan Zabo 614-221-7614 susanz@ohanet.org • For any other information: Deborah Jordan 419-842-0800 djordan@hcno.org

44. Questions