Cancer and Heart Disease, A Case for Working Collaboratively

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<ul><li> 1. Cancer and Heart Disease, A Case for Working Collaboratively to Reduce Tobacco Use Sandra Villalaz, RN, MPH, CHES Community Manager for Health Initiatives Central Texas Region, American Cancer Society </li> <li> 2. American Cancer Society Mission The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service. </li> <li> 3. Objectives <ul><li>Describe one health care system level initiative to reduce tobacco use among patients. </li></ul><ul><li>Identify three stakeholders critical to creating system level change and why. </li></ul><ul><li>List two best practices and at least three community level resources available to assist in client smoking cessation attempts. </li></ul></li> <li> 4. </li> <li> 5. Concern <ul><li>Healthy People 2010 goal to reduce tobacco use to 12 % not met. </li></ul><ul><li><ul><li>Actually we only met this goal for population 65 and older. </li></ul></li></ul><ul><li>American Cancer Society Goal for 2015 is the same. </li></ul></li> <li> 6. The Problem <ul><li>Smoking damages nearly every cell </li></ul><ul><li>in your body. </li></ul><ul><li>It can cause: </li></ul><ul><li><ul><li>Cancers </li></ul></li></ul><ul><li><ul><li>COPD </li></ul></li></ul><ul><li><ul><li>Heart Disease </li></ul></li></ul><ul><li><ul><li>CV Disease </li></ul></li></ul><ul><li><ul><li>GI ulcers/periodontal disease </li></ul></li></ul><ul><li><ul><li>Reproductive effects </li></ul></li></ul><ul><li><ul><li>Eye disorders </li></ul></li></ul><ul><li>Richard Carmona, Surgeon General of the US, Surgeon General Report, May 2004 </li></ul></li> <li> 7. <ul><li>Case Study and Stakeholders </li></ul></li> <li> 8. The Challenge <ul><li>Seized the opportunity </li></ul><ul><li><ul><li>Meeting with Austin Heart, PA Chief Operating Officer </li></ul></li></ul><ul><li>Presented the challenge </li></ul><ul><li><ul><li>Asked what protocol was used for tobacco users </li></ul></li></ul><ul><li><ul><li>Prepared for the meeting </li></ul></li></ul></li> <li> 9. Tobacco Use and Heart Disease Statistics <ul><li><ul><li> As many as 30 percent of all deaths in the United States each year from heart attack are attributable to cigarette smoking (2) </li></ul></li></ul><ul><li><ul><li> Smoking-caused heart disease results in more deaths per year than smoking-caused lung cancer (4) </li></ul></li></ul><ul><li><ul><li> Tobacco use increases blood pressure and risk of stroke (1) </li></ul></li></ul><ul><li><ul><li> Women who smoke and use oral contraceptives greatly increase their risk of heart attack and stroke (4) </li></ul></li></ul><ul><li><ul><li> Smokers risk of a heart attack is two to four times greater than that of non-smokers (3) </li></ul></li></ul><ul><li><ul><li>1. American Heart Association, Inc., Cigarette Smoking and Cardiovascular Disease, July 18, 2005 </li></ul></li></ul><ul><li><ul><li>American Heart Association, Inc., Circulation, 1997; 96:3243-3247, Cigarette Smoking, Cardiovascular Disease, and Stroke A Statement for Healthcare Professionals From the American Heart Association, 1997 </li></ul></li></ul><ul><li><ul><li>American Heart Association, Inc., Risk Factors and Coronary Heart Disease, July 18, 2005 </li></ul></li></ul><ul><li><ul><li>U. S. Department of Health and Human Services, State Cardiovascular Disease Highlights, 1997, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1997 </li></ul></li></ul></li> <li> 10. Austin Heart, PA <ul><li>47 physicians provide care at 13 Central Texas office locations 8 counties </li></ul><ul><li>comprehensive range of services include prevention , general cardiology, vascular care , electrophysiology, and interventional cardiovascular services. </li></ul></li> <li> 11. Article from Austin Heart Newsletter Feb 2009 <ul><li>Smoking Remains the No 1 Cause of Preventable Death in the United States </li></ul><ul><li>Did you know that cigarette smokers are two to four times </li></ul><ul><li>more likely to develop coronary heart disease than nonsmokers. </li></ul><ul><li>Smokers are also more than 10 times as likely as </li></ul><ul><li>nonsmokers to develop peripheral artery disease. After one </li></ul><ul><li>year off of cigarettes the excess risk of coronary heart </li></ul><ul><li>disease caused by smoking is reduced by half. 15 years </li></ul><ul><li>after quitting, the risk is similar to that for people who have never smoked. </li></ul></li> <li> 12. The Meeting <ul><li>Responded with information and orientation to service after learning about the practice </li></ul><ul><li><ul><li>Met with Medical Director </li></ul></li></ul><ul><li><ul><li>Offered educational materials and briefing on American Cancer Society Quitline . </li></ul></li></ul><ul><li><ul><li>Offered Professional Education </li></ul></li></ul></li> <li> 13. Healthcare Professional Ed <ul><li>Provided Provider and Nursing education as well as patient materials for 13 locations. </li></ul><ul><li><ul><li>Involved appropriate level of professionals </li></ul></li></ul></li> <li> 14. Tobacco half the problem <ul><li>Only 70% of primary care physicians ask their patients if they use tobacco. </li></ul><ul><li>Only 40% take action. </li></ul></li> <li> 15. Providing Appropriate Tobacco Cessation Assistance is Important <ul><li>70% of smokers want to quit. </li></ul><ul><li>93% of smokers who try to quit resume regular smoking within one year. </li></ul><ul><li>Five to seven attempts are usually required to succeed. </li></ul></li> <li> 16. CDC Recommendations <ul><li>Tobacco dependence is a chronic condition that requires repeated interventions </li></ul><ul><li>Every patient should be offered a treatment </li></ul><ul><li><ul><li>Patients willing to try to quit-should be offered effective treatments </li></ul></li></ul><ul><li><ul><li>Patients unwilling to try to quit-should be offered a brief intervention designed to increase their motivation </li></ul></li></ul></li> <li> 17. Effective Tobacco Dependence Interventions <ul><li>Fiore MC, Bailey, Cohen SJ, et. al. Treating Tobacco Use and Dependence . Rockville, MD: US Department of Health and Human Services. Public Health Service. October 2008. </li></ul><ul><li>MMWR/Recommendations and Reports: November 10,2000/Vol. 49/No.RR-12. A report on findings. </li></ul><ul><li>American Journal of Preventive Medicine.AM J Prev Med 2001:20 (2S); 16-66. A report on findings and evidence. </li></ul></li> <li> 18. Austin Heart, PA <ul><li>Physicians will address smoking and quitting. </li></ul><ul><li><ul><li>Physicians advice to quit is an important motivator. </li></ul></li></ul><ul><li><ul><li>Nurses and office staff will answer questions, help with resources and encourage patients. </li></ul></li></ul><ul><li>Patients can make an appointment with physician for smoking cessation support and resources. </li></ul><ul><li><ul><li>Insurance provides payment to physicians for smoking cessation interventions. </li></ul></li></ul><ul><li>All personnel are responsible for encouraging and promoting a healthy lifestyle. </li></ul></li> <li> 19. Changes reported <ul><li>2007 we had 4 physicians counsel 73 patients. </li></ul><ul><li>2008 we had 4 physicians counsel 96 patients. </li></ul><ul><li>2009 we had 36 physicians counsel 603 patients </li></ul></li> <li> 20. Good News and Not such Good News <ul><li>Document in the EMR patients smoking status </li></ul><ul><li>Documented what counseling and support services were provided. </li></ul><ul><li>Documented the appropriate diagnosis codes for tobacco abuse. </li></ul><ul><li>BUT have not tracked if patients have actually stopped. </li></ul></li> <li> 21. <ul><li>Best Practices and Resources </li></ul></li> <li> 22. The Stages of Change <ul><li>Pre-contemplation: At this stage, the tobacco user is not thinking seriously about quitting right now. </li></ul><ul><li>Contemplation: The tobacco user is actively thinking about quitting but is not quite ready to make a serious attempt yet. </li></ul><ul><li>Preparation: Tobacco users in the preparation stage seriously intend to quit in the next month and often have tried to quit in the past 12 months. They usually have a plan. </li></ul><ul><li>Action: This is the first 6 months when the user is actively quitting. </li></ul><ul><li>Maintenance: This is the period of 6 months to 5 years after quitting when the ex-user is aware of the danger of relapse and take steps to avoid it. </li></ul></li> <li> 23. 5 As <ul><li>A sk systematically identify all tobacco users at every visit </li></ul><ul><li>A dvise-strongly urge tobacco users to quit with each visit </li></ul><ul><li>A ssess-determine willingness to make a quit attempt (within 30 days) </li></ul><ul><li>A ssist-aid patient in quitting </li></ul><ul><li>A rrange-schedule a follow up contact </li></ul></li> <li> 24. </li> <li> 25. 5 Rs for those unwilling to quit <ul><li>R elevance-encourage pt to identify personal reason to quit </li></ul><ul><li>R isks-ask pt to list negative consequences of smoking </li></ul><ul><li>R ewards-list potential benefits of quitting </li></ul><ul><li>R oadblocks-identify barriers </li></ul><ul><li>R epetition-repeat with each visit </li></ul></li> <li> 26. </li> <li> 27. <ul><li>When: </li></ul><ul><li>Patients who use tobacco are identified; </li></ul><ul><li>Providers receive information to help them help their patients understand the risks and dangers </li></ul><ul><li>Results in: </li></ul><ul><li>Delivery of advice to quit by providers </li></ul><ul><li>Number of patients who do quit </li></ul>Provider Reminder Systems </li> <li> 28. Nurses <ul><li>You are an invaluable resource. </li></ul><ul><li>Patients are more likely to quit successfully with the nurses support. (Good, Frazier, Wetta-Hall, Ablah, &amp; Molgaard, 2004) </li></ul><ul><li>If you dont mention it to your patients, they wont see it as important. </li></ul><ul><li>Nurses are a trusted professional. </li></ul><ul><li>We are failing our patients if we dont offer smoking cessation help. (Roberts, 2002) </li></ul></li> <li> 29. Common Barriers <ul><li>Patients perceived or actual lack of interest or motivation </li></ul><ul><li>Lack of time and skill </li></ul><ul><li>Lack of knowledge and resources </li></ul><ul><li>Thought that it is an invasion of patient privacy </li></ul><ul><li>Negative message may scare patients away. </li></ul><ul><li>(Good, et al, 2004) </li></ul></li> <li> 30. Behavioral Interventions &amp; 5 month Quit Rates <ul><li>Self-help: 12.3% </li></ul><ul><li>Proactive telephone counseling: 13.1% </li></ul><ul><li>Group counseling: 13.9% </li></ul><ul><li>Individual counseling: 16.8% </li></ul><ul><li>The American Cancer Societys Quitline has a 1 year quit rate of 36%. </li></ul><ul><li>The addition of pharmacologic agents have significantly improved success rates. </li></ul><ul><li>Hopkins, David, et al. Reviews of Evidence Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke, 2001. Am J Prev Med 2001;20(2):16-66. </li></ul></li> <li> 31. ACS Quit For Life <ul><li>It only takes 30 seconds to refer a patient to a toll-free tobacco-cessation quitline. </li></ul><ul><li>Quitlines are staffed by trained cessation experts who tailor a plan and advice for each caller. </li></ul><ul><li>Calling a quitline can increase a smokers chance of successfully quitting. </li></ul></li> <li> 32. Ethical Considerations <ul><li>Screening </li></ul><ul><li><ul><li>Ask at each visit </li></ul></li></ul><ul><li>Efficacious Treatment </li></ul><ul><li><ul><li>Recommending Smoking Cessation </li></ul></li></ul><ul><li>Counseling </li></ul><ul><li><ul><li>Group, Individual or Phone </li></ul></li></ul></li> <li> 33. ACS Community Resources <ul><li>Client </li></ul><ul><li>ACS Quit For Life - a quitline In Texas: </li></ul><ul><li><ul><li>1-877-YES-QUIT (877-937-7848) </li></ul></li></ul><ul><li><ul><li>Pamphlets to provide information </li></ul></li></ul><ul><li><ul><li><ul><li>Spanish/ English </li></ul></li></ul></li></ul><ul><li><ul><li>Wallet card-Spanish/English </li></ul></li></ul><ul><li>American Cancer Society </li></ul><ul><li><ul><li> </li></ul></li></ul><ul><li><ul><li>1-800-ACS-2345 </li></ul></li></ul><ul><li><ul><li>American Cancer Society Fresh Start </li></ul></li></ul></li> <li> 34. Community Resources <ul><li>Professional </li></ul><ul><li>Quick Guide to Helping Tobacco Users-Toolkit </li></ul><ul><li><ul><li>(5As and 5Rs cards for exam rooms) pdf available from the Texas Dept of State Health Service </li></ul></li></ul><ul><li>Ask and Act American Academy of Family Practitioners </li></ul><ul><li>ACS Quit For Life Promotional Materials- a quitline in Texas </li></ul><ul><li>American Cancer Society </li></ul><ul><li><ul><li> </li></ul></li></ul><ul><li><ul><li>1-800-ACS-2345 </li></ul></li></ul><ul><li><ul><li>American Cancer Society Fresh Start -facilitator online training - </li></ul></li></ul></li> <li> 35. Conclusion <ul><li>There is no clinical intervention available today that can reduce illness, prevent death, and increase quality of life more than effective tobacco treatment interventions. </li></ul><ul><li>Be part of the solution. </li></ul><ul><li>Be sure providers address tobacco addiction with every visit. </li></ul></li> <li> 36. [email_address] 512-919-1854 </li> </ul>