Bronx BREATHES: Resources and Technical Assistance for Improved Tobacco Treatment

1. Bronx BREATHES: Resources and Technical Assistance for Improved Tobacco Treatment Barbara Hart, MPA David Lounsbury, PhD Claudia Lechuga, MS Hal Strelnick, MD Bronx Einstein Alliance for Tobacco-free Health MMG QA Council Meeting 5.21.09

2. Declining Rates of Smoking in NYC

3. The Role of Primary Care Providers in Tobacco Treatment • Brief counseling intervention by health care providers has been shown to effectively promote smoking cessation • However, providers face considerable pressure to address multiple patient care concerns during increasingly brief clinical visits • Facilities with tobacco screening systems are associated with a 66% rate of clinician intervention • Bronx BREATHES is available to help providers address these challenges (Fiore et al., 2008) (Davis et al. 1995; Cabana et al., 1999) (Fiore et al., 2008)

4. Efficacy of Tobacco Counseling Interventions Brief counseling • 3-10 minutes • Targets smokers who are willing (5 As), unwilling (5 Rs), and those who recently quit (relapse prevention) Intensive counseling • Total clinician-client time > 30 minutes with at least 4 sessions • Tend to be coordinated by tobacco dependence specialists • Multiple clinician types Strong dose response between counseling intensity (time) and cessation success (Cromwell et al., 1997; Fiore et al., 2008)

5. Brief Counseling Intervention: The 5As • Askabout tobacco use • Identify and document tobacco use status for every patient at every visit • Adviseto quit • In a clear, strong and personalized manner urge every tobacco user to quit • Assesswillingness to quit • Is the tobacco user willing to make a quit attempt at this time? • Assistin quit attempt • If willing to quit, use counseling, pharmacotherapy, and/or other resources to help patient quit • Arrangefollow up • Schedule follow-up contact, preferably within the first week after the quit date (Fiore et al., 2008)

6. Motivational Intervention for Patients Not Ready to Quit: The 5Rs • Relevanceto quitting smoking • Most helpful to make it personal and specific • Risksassociated with cont’d smoking • Highlight risks that seem most relevant to the patient • Rewardsto being tobacco-free • Identify potential benefits to being smoke-free • Roadblocksto successfully quitting • Address elements of treatment that could alleviate barriers to quitting • Repetitionof assessment • Unmotivated patients should be asked each and every visit (Fiore et al., 2008)

7. The Utility of Performance Monitoring and Feedback Academic Detailing (educational office visits) are a promising way to change provider behaviors Combined strategies, namely individual instruction with peer review & feedback about performance, were among the most effective interventions for medical professionals: • Typically target drug prescribing behaviors • No clear association between number of visits and impact on practice change (O’Brien et al, 2006 – Cochrane Review)

8. Medicare Codes and Reimbursement

9. Medicaid Codes and Reimbursement To be used with one of these ICD-9 Codes: 630-677, V22, V23, V2

10. Bronx BREATHES:Support Services for Clinicians • Training and follow-up for providers • Design and implement systems to identify and monitor tobacco users at each patient visit • Foster patient referral to intensive smoking cessation services in the Bronx

11. Bronx BREATHES:Additional Resources • NYS Quitline: 866-NYQUITS • Free telephone counseling in English, Spanish, and several other languages • Free NRT • Referrals to local counseling programs • Free educational materials • Fax-To-Quit • Patients that providers refer are contacted by Quitline specialists and offered same services as above • Progress report sent back to you

12. Thank you! Barbara Hart, MPA, Project ManagerBronx BREATHESAlbert Einstein College of Medicine 1300 Morris Park AvenueMazer Building, Suite 100Bronx, New York 10461 bhart@aecom.yu.edu e-mail 718.430.2601 phone 718.430.8816 faxhttp://www.bronxbreathes.orgweb