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KICKS BUTT!

KICKS BUTT!. Tim McAfee, MD, MPH tim.mcafee@freeclear.com Clinical & Behavioral Sciences Free & Clear 206-876-2551. THE GROUP HEALTH STORY. 1991 report: Decreasing Tobacco Use at Group Health During the 1990s.

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KICKS BUTT!

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  1. KICKS BUTT! Tim McAfee, MD, MPH tim.mcafee@freeclear.com Clinical & Behavioral Sciences Free & Clear 206-876-2551

  2. THE GROUP HEALTH STORY

  3. 1991 report: Decreasing Tobacco Use at Group Health During the 1990s Goal: “Decrease the prevalence of tobacco use at Group Health by 50% from 1985 level of 25% to 12.5% by the year 2000” Authors: Sue Curry Sallie Dacey Doug Louie Tim McAfee Neal Sofian Larry Ziedman

  4. 1991 report: Decreasing Tobacco Use at Group Health During the 1990s Objective: “A comprehensive coordinated set of interventions will be available at Group Health covering all the stages of tobacco use” Key Partners: Tracy Orleans NCI & CDC OSH Michael Fiore/USPHS GL group/ATMC Ed Wagner & Sue Curry (CHS) Robert S. Thompson (DPC) Bill Beery & Anne Smith (CHP) Key Partners Phil Nudelman/Cheryl Scott /Scott Armstrong (CEOs) Al Truscott/Louise Liang/ Hugh Straley (Med. Directors) Jim Truess (CFO) Hundreds of VPs, managers and directors Thousands of physicians, nurses, MAs, pharmacists, etc Tens of thousands of patients

  5. Adult Smoking Prevalence:

  6. 1991 - COP report: 7 Strategies 1)”Identify, track and treat tobacco use with the same vigor as other diseases with significant morbidity and mortality” 2)“Advocate for coverage of tobacco services where clinical effectiveness has been convincingly established” 3) “Encourage adolescents to never become tobacco users, both during clinic contacts and through school and community outreach” 4)”Encourage and support population-based projects to decrease tobacco use” 5)”Make tobacco a top lobbying priority of the GHC legislative affairs office” 6) “Develop educational programs about tobacco use and services for staff at all levels, including nursing, physician, clerical, medical assistant and pharmacy. Encourage and support on-going programs to decrease the prevalence of tobacco use among employees” 7)”Treat coverage for smokers in the same manner we treat coverage for other individuals with significant chronic diseases”

  7. Elements of comprehensive approach • Reliance upon evidence • Identifying tobacco users in primary care • Training practice teams in brief advice • Referral to phone and group programs • Coverage for counseling & medications • Integration with Prevention, Quality & Chronic Care initiatives • Support for community policy change

  8. Health system opportunity:

  9. SMOKE-FREE FITS GHC MISSION Fits GHC’s preventive care and health promotion mission Supported by marketing and communications Issue of quarterly member magazine

  10. Top take-home lessons Advise Ask Refer • Science is a good starting place • It’s a product, marketing and sales challenge! • Hold on to the tiger’s tail • People, systems, and measurement make a difference • Design for end-users

  11. Research Collaborations • NEngJMed 9/3/98 339:673-679 Curry et al

  12. Primary care: tobacco status identification on all charts * > 85% in all 29 primary care clinics

  13. Provider advice to smokers *p<0.05 for both ** Top10% of HEDIS

  14. Documentation of Patient Tobacco Status using the TRF: TOBACCO USE STATUS (circle one) Non-Tobacco user 4 Current Tobacco User 1 Recent Quitter <1 year 2 PROVIDER INTERVENTION Tobacco Use Disorder 305.1 /Intervention

  15. TRF Tobacco status identification:

  16. Cessation Program Quality Improvement Why: Excellent program, but little impact due to low reach (in 1992 only 180 participants/year) Difficult to sustain clinic-based assistance/follow-up

  17. Free & Clear improvements • Removal of financial barriers • Integrated pharmacotherapy: • program assesses, generates Rx • individualized • ensures follow-up received • Strong quality controls/reporting • Promotional support

  18. Free & Clear Participation Group Health Enrollees One-year quit rate: 25-30% (30-day abstinence ~ Intent-to-Treat)

  19. Policy/population tobacco efforts • NW Health articles • Smoke-free campuses • Master Settlement Agreement • Seattle Times ad ban • Labor and Industry worksite ban • Access/merchant fee bill • Defeating “Smokers Rights” bill • Testimony/op-ed pieces • Passage of two state initiatives • Free & Clear external & state quit lines

  20. I – 773 and I-901 I-773 2001 WA state initiative • Raised tax on pack of cigarettes 60 cents • “Guarantees” 26 million to Tobacco Control I-901 2005 Clean Indoor Air • 100% ban GHC Board endorsed, contributed $$, & lobbyist/staff time for both

  21. “To serve the greatest number…”

  22. Free & Clear Participation Ratesper 1000 (Note: 2004 rates annualized based on first 2 quarters)

  23. Smoking Prevalence 2003by GHC Delivery System Commercially Insured Adults aged 18-65 years (Data Source: CAHPS Adult Survey 2002-2004)

  24. Chronic Care Model • Organization of care • Clinical information systems • Delivery system design • Decision support • Self-management support • Community resources Glasgow RE, Orleans CT, Wagner EH. Does the Chronic Care Model serve also as a template for improving prevention? The Milbank Quarterly, Vol. 79, No. 4, 2001.

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