Cherokee Health Systems Encouraging Tobacco Cessation Through the Five A’s: Ask, Advise, Assess,...
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Cherokee Health Systems
Encouraging Tobacco Cessation
Through the Five A’s:Ask, Advise, Assess, Assist, Arrange
Encouraging Tobacco Cessation
Through the Five A’s:Ask, Advise, Assess, Assist, Arrange
Mary Clare Champion, Ph.D.Cherokee Health Systems
Kentucky Primary Care Association Annual ConferenceOctober 18, 2011
Lexington, KY
Mary Clare Champion, Ph.D.Cherokee Health Systems
Kentucky Primary Care Association Annual ConferenceOctober 18, 2011
Lexington, KY
Cherokee Health Systems
"Starting today, every doctor, nurse, health plan, purchaser, and medical school in America should make treating tobacco dependence a top priority."
—David Satcher, MD, Ph.D.Former U.S. Surgeon GeneralDirector, National Center for
PrimaryCare, Morehouse School of Medicine
"Starting today, every doctor, nurse, health plan, purchaser, and medical school in America should make treating tobacco dependence a top priority."
—David Satcher, MD, Ph.D.Former U.S. Surgeon GeneralDirector, National Center for
PrimaryCare, Morehouse School of Medicine
Cherokee Health Systems
According to the Centers for Disease
Control:
According to the Centers for Disease
Control:• Approximately 20% of Americans
smoke• Disparities present
– 49.1% of adults with GED smoke – 31.1% of adults who live below
poverty level smoke
• Approximately 20% of Americans smoke
• Disparities present– 49.1% of adults with GED smoke – 31.1% of adults who live below
poverty level smoke
Cherokee Health Systems
According to the Centers for Disease Control’s Office on Smoking and
Health:
According to the Centers for Disease Control’s Office on Smoking and
Health:
• More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.
• Smoking cigarettes, pipes, or cigars increases the risk of dying from cancers of the lung, esophagus, larynx, and oral cavity.
• More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.
• Smoking cigarettes, pipes, or cigars increases the risk of dying from cancers of the lung, esophagus, larynx, and oral cavity.
Cherokee Health Systems
From the CDC, cont.Cigarette smoking causes about 1 of every 5 deaths in the United States each year. Cigarette smoking is estimated to cause the following:•443,000 deaths annually (including deaths from secondhand smoke)•49,400 deaths per year from secondhand smoke exposure•269,655 deaths annually among men•173,940 deaths annually among women
Cigarette use causes premature death:•On average, adults who smoke cigarettes die 14 years earlier than nonsmokers.•Based on current cigarette smoking patterns, an estimated 25 million Americans who are alive today will die prematurely from smoking-related illnesses, including 5 million people younger than 18 years of age.
Cherokee Health Systems
Who can use the 5 A’s?Who can use the 5 A’s?
• Anyone!– Doctors– Nurse Practitioners– Psychologists– Social Workers– Nurses– Ancillary staff
• Anyone!– Doctors– Nurse Practitioners– Psychologists– Social Workers– Nurses– Ancillary staff
Cherokee Health Systems
ASKIdentify ALL tobacco users
at EVERY visit
ASKIdentify ALL tobacco users
at EVERY visitVital Signs
Blood Pressure:__________________________________________
Pulse: _____________________ Weight: _____________________
Temperature: ____________________________________________
Respiratory Rate: ________________________________________
Tobacco Use: (circle one) Current Former Never
Fiore MC, Bailey WC, Cohen SJ, et. al. Treating Tobacco Use and Dependence. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. October 2000.
Vital Signs
Blood Pressure:__________________________________________
Pulse: _____________________ Weight: _____________________
Temperature: ____________________________________________
Respiratory Rate: ________________________________________
Tobacco Use: (circle one) Current Former Never
Fiore MC, Bailey WC, Cohen SJ, et. al. Treating Tobacco Use and Dependence. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. October 2000.
Cherokee Health Systems
ASKASK
• Options for tracking include:– Adjusting vital sign documentation to
include tobacco assessment– Tobacco status stickers for paper
charts– Tag in electronic medical record,
reminder texts for documentation
• Options for tracking include:– Adjusting vital sign documentation to
include tobacco assessment– Tobacco status stickers for paper
charts– Tag in electronic medical record,
reminder texts for documentation
Cherokee Health Systems
Why ask?Why ask?
• Important to understand tobacco use as a chronic illness
• Anticipate periods of relapse• Heightened awareness
• Important to understand tobacco use as a chronic illness
• Anticipate periods of relapse• Heightened awareness
Cherokee Health Systems
ADVISEADVISE
• Strongly encourage all tobacco users to quit– Clear– Strong– Personalized
• Strongly encourage all tobacco users to quit– Clear– Strong– Personalized
Cherokee Health Systems
ASSESSASSESS
• Is the patient willing to make a quit plan within the next 30 days?
• If yes,– Provide assistance with quit plan– Deliver treatment needed for plan or
refer to appropriate treatment– Provide additional information for special
populations (adolescents, pregnant women)
• Is the patient willing to make a quit plan within the next 30 days?
• If yes,– Provide assistance with quit plan– Deliver treatment needed for plan or
refer to appropriate treatment– Provide additional information for special
populations (adolescents, pregnant women)
Cherokee Health Systems
ASSESSASSESS
• What if the person says, “No!”
• Provide motivational interventions– Consider the 5 R’s
• Relevance• Risks• Rewards• Roadblocks• Repetition
• What if the person says, “No!”
• Provide motivational interventions– Consider the 5 R’s
• Relevance• Risks• Rewards• Roadblocks• Repetition
Cherokee Health Systems
ASSESSASSESS
• Be prepared to repeat these interventions as necessary
• Remember that even if the patient continues to say, “NO!,” when asked about a quit plan, repeated interventions still contribute to heightened awareness
• Be prepared to repeat these interventions as necessary
• Remember that even if the patient continues to say, “NO!,” when asked about a quit plan, repeated interventions still contribute to heightened awareness
Cherokee Health Systems
How to Assist?How to Assist?
• Help with quit plan:– Set a date– Tell family/friends– Anticipate
challenges– Remove tobacco
products
• Help with quit plan:– Set a date– Tell family/friends– Anticipate
challenges– Remove tobacco
products
• Provide practical help:– Goal of abstinence– Review past quit
attempts– Discuss triggers– Risk of alcohol use– Peers who smoke
• Provide practical help:– Goal of abstinence– Review past quit
attempts– Discuss triggers– Risk of alcohol use– Peers who smoke
Cherokee Health Systems
How to Assist?How to Assist?
• Intra-treatment social support:– Support of
providers and staff– Consider smoking
cessation group in the practice
• Intra-treatment social support:– Support of
providers and staff– Consider smoking
cessation group in the practice
• Extra-treatment social support:– Support outside of
office• Friends• Family• Online supports
• Extra-treatment social support:– Support outside of
office• Friends• Family• Online supports
Cherokee Health Systems
How to Assist?How to Assist?
• Consider pharmacotherapy:– Consult medical
providers with use of medicines, inhalers, patches, and/or nicotine replacement gum.
• Consider pharmacotherapy:– Consult medical
providers with use of medicines, inhalers, patches, and/or nicotine replacement gum.
• Supplementary materials:– Collect materials
from local/federal agencies
– Have materials readily available at all workstations
• Supplementary materials:– Collect materials
from local/federal agencies
– Have materials readily available at all workstations
Cherokee Health Systems
ARRANGEARRANGE
• Provide follow-up contact– First follow-up preferably within the
week after the quit date– Second follow-up within the month
• Provide follow-up contact– First follow-up preferably within the
week after the quit date– Second follow-up within the month
Cherokee Health Systems
Resources for CliniciansResources for Clinicianshttp://www.surgeongeneral.gov/tobacco/tobaqrg.htm(Reference guide for clinicians)
http://www.theipcrg.org/resources/IPCRG%20SMOKE%20CES%20TO%20PRINT%20V2%20FINAL%20Oct%2007.pdf(Printable handout for clinician use)
http://www.tnpca.org/displaycommon.cfm?an=1&subarticlenbr=66(TPCA’s resource website, multiple links/documents)
http://www.surgeongeneral.gov/tobacco/tobaqrg.htm(Reference guide for clinicians)
http://www.theipcrg.org/resources/IPCRG%20SMOKE%20CES%20TO%20PRINT%20V2%20FINAL%20Oct%2007.pdf(Printable handout for clinician use)
http://www.tnpca.org/displaycommon.cfm?an=1&subarticlenbr=66(TPCA’s resource website, multiple links/documents)
Cherokee Health Systems
Other resources – for patients
Other resources – for patients
www.smokefree.gov www.ahrq.gov/path/tobacco.html
1-800-QUIT-NOW
http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/you_can_quit/
www.smokefree.gov www.ahrq.gov/path/tobacco.html
1-800-QUIT-NOW
http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/you_can_quit/