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Proactive Referrals: Increasing Cessation Recruitment by Building Collaborations

Proactive Referrals: Increasing Cessation Recruitment by Building Collaborations. Pamela Powers, MPH; Robert Leischow, MPH; Mary Gilles, MD; Rebecca Ruiz-McGill; Amy Dye; Susan Larsen; James Ranger-Moore, Ph.D. Network for Information and Counseling - Arizona Smokers’ Helpline

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Proactive Referrals: Increasing Cessation Recruitment by Building Collaborations

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  1. Proactive Referrals: Increasing Cessation Recruitment by Building Collaborations Pamela Powers, MPH; Robert Leischow, MPH; Mary Gilles, MD; Rebecca Ruiz-McGill; Amy Dye; Susan Larsen; James Ranger-Moore, Ph.D. Network for Information and Counseling - Arizona Smokers’ Helpline Mel & Enid Zuckerman Arizona College of Public Health National Conference on Tobacco or Health Boston, Mass., Dec. 11, 2003 Arizona Department of Health Services - Tobacco Education and Prevention Program

  2. Tobacco Control in Arizona • Comprehensive system funded by tobacco tax ($1.18) • 15 Community-based tobacco control projects • 11 Tribal Projects • Statewide Services: Helpline, Information Technology and Internet Services, Training and TA, Policy Tracking, Media, Evaluation • Visit www.TEPP.org for additional details Arizona Department of Health Services - Tobacco Education and Prevention Program

  3. Arizona Smokers’ Helpline • Created in 1995 at the University of Arizona • Funded by ADHS/TEPP to provide: • Bilingual proactive telephone counseling • Bilingual mailed self-help publications • Information and referral to local services • Reduced cost for NRT or Zyban • Pre-recorded voicemail and FAX quit tips • Cessation technical assistance • www.ASHLine.org with interactive decision-making tools and E-mail Arizona Department of Health Services - Tobacco Education and Prevention Program

  4. Levels of Service Based Upon Client Choice • Questions Only • Information Only • Information and Referral • Counseling • Currently Quit • Calling for Another • Friend or relative • Healthcare provider • Human Resources Arizona Department of Health Services - Tobacco Education and Prevention Program

  5. Statewide Recruitment Efforts Traditional Paid Advertising FY 98-99, FY 99-00, FY 00-01 Arizona Department of Health Services - Tobacco Education and Prevention Program

  6. What motivates people to seek quit-tobacco services? • Paid Advertising • Television • Radio • Newspaper • Referrals • Friends, family, former clients • Community-based tobacco projects • Healthcare providers, Worksites • Community Events Interruption Marketing • Billboards • Telephone book Permission Marketing Arizona Department of Health Services - Tobacco Education and Prevention Program

  7. Multiple TV Ad Campaigns Effective TV advertising increased Helpline calls from 500/quarter to 500/week Arizona Department of Health Services - Tobacco Education and Prevention Program

  8. Statewide Recruitment Efforts Budget Cuts Brought Changes in Strategy Promoting Referrals FY 01-02, FY 02-03 Arizona Department of Health Services - Tobacco Education and Prevention Program

  9. Public Relations & Outreach • Public Relations • News and feature story placement • Guest appearances on radio and TV talk shows • Speakers’ Bureaus • Newsletters and trade publications • Sponsorships • Listserv promotions • Outreach • Targeted initiatives with specific groups • Direct mail incentives to referring agencies Arizona Department of Health Services - Tobacco Education and Prevention Program

  10. Proactive Referral Networks • Community projects • Pilot project: referrals from Mohave County make up 68% of the proactive community referrals (FY 01-02) • WIC clinics • Pilot project: recruitment from Mohave County WIC increased 340% in 3 quarters Arizona Department of Health Services - Tobacco Education and Prevention Program

  11. ProactiveReferral Proactive Referrals • Outside agency conducts brief intervention • Gains client consent for Helpline call • Faxes referral to Helpline • Helpline calls, recruits client into services, doesintake form Arizona Department of Health Services - Tobacco Education and Prevention Program

  12. Proactive Referral System: Vision & Goals • Vision: • To create a uniform manner in which to refer clients to free, research-based, quit-tobacco services. • Goals: • Increase access to services statewide • Increase cessation recruitment statewide • Build relationships with healthcare practitioners (HCPs) • Build relationships with Women, Infant, and Children clinics (WIC) Arizona Department of Health Services - Tobacco Education and Prevention Program

  13. Proactive Referral System: Vision & Goals • Goals (continued): • Increase awareness of tobacco tax-funded services • Create system changes within healthcare • Provide a mechanism for evaluation of productivity and cost effectiveness of training and referral system • Decrease the prevalence of tobacco use Arizona Department of Health Services - Tobacco Education and Prevention Program

  14. Smokers’ Helpline: Referral Hub Arizona Department of Health Services - Tobacco Education and Prevention Program

  15. Healthcare Provider Outreach Arizona Department of Health Services - Tobacco Education and Prevention Program

  16. Provider Advice to Quit • Most Americans see doctor annually • Physician advice to quit is a powerful motivator-- even advice as brief as 3 minutes can make a difference • 5 “A’s”: every office visit, every patient • Askif patient smokes • Assess readiness to quit • Advise to quit • Assistin quitting/finding services • Arrange for cessation services Arizona Department of Health Services - Tobacco Education and Prevention Program

  17. Healthcare Provider Outreach • Give healthcare providers the tools they need on an ongoing basis • Basic cessation intervention training (5As) • Collateral materials for waiting room • Strategies to change systems (chart stickers, referral forms, NRT benefits, free cessation services, training, incentives) • Outcome results per referral Arizona Department of Health Services - Tobacco Education and Prevention Program

  18. Healthcare Provider Outreach • Distribute aggregate client data to MCOs • Mail tailored packets MCO clients • Mail thank-you letters, incentives, and publications to referring HCPs Arizona Department of Health Services - Tobacco Education and Prevention Program

  19. Recruitment Results Are healthcare providers using the proactive referral system? Have changes in recruitment strategies influenced client characteristics? Arizona Department of Health Services - Tobacco Education and Prevention Program

  20. Recruitment Strategies Arizona Department of Health Services - Tobacco Education and Prevention Program

  21. Who calls the Helpline? Arizona Department of Health Services - Tobacco Education and Prevention Program

  22. Helpline Recruitment Sources Arizona Department of Health Services - Tobacco Education and Prevention Program

  23. Referral Results Arizona Department of Health Services - Tobacco Education and Prevention Program

  24. Referral Results Arizona Department of Health Services - Tobacco Education and Prevention Program

  25. Referral Results • Healthcare providers (HCPs) are more likely to use proactive referral system than county health departments • Although Speakers’ Bureau training and other outreach activities have reached hundreds of HCPs, only a core group uses the system. (113 HCPs of 2,555 in database) • Acceptance of proactive referral system continues to grow Arizona Department of Health Services - Tobacco Education and Prevention Program

  26. Services Arizona Department of Health Services - Tobacco Education and Prevention Program

  27. Call Language Arizona Department of Health Services - Tobacco Education and Prevention Program

  28. Hispanic Ethnicity Arizona Department of Health Services - Tobacco Education and Prevention Program

  29. Health Insurance Arizona Department of Health Services - Tobacco Education and Prevention Program

  30. Gender Arizona Department of Health Services - Tobacco Education and Prevention Program

  31. Future Analyses • Further investigate changes in clientele and recruitment (i.e., age, pregnancy status, WIC status, education) • Track and evaluate proactive referrals • What are the most productive referral sources? • How can the process be changes to increase recruitment of low SES clients? • How with discounted NRT provision change recruitment in the future? Arizona Department of Health Services - Tobacco Education and Prevention Program

  32. 1-800-55-66-222 For cessation counseling: www.ASHLine.org For additional evaluation information: www.TEPP.org/evaluation Arizona Smokers’ Helpline Mel & Enid Zuckerman Arizona College of Public HealthTucson, Arizona Arizona Department of Health Services - Tobacco Education and Prevention Program

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