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- 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
- 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.
- 3. Objectives
- Describe one health care system level initiative to reduce tobacco use among patients.
- Identify three stakeholders critical to creating system level change and why.
- List two best practices and at least three community level resources available to assist in client smoking cessation attempts.
- 5. Concern
- Healthy People 2010 goal to reduce tobacco use to 12 % not met.
- Actually we only met this goal for population 65 and older.
- American Cancer Society Goal for 2015 is the same.
- 6. The Problem
- Smoking damages nearly every cell
- in your body.
- It can cause:
- Heart Disease
- CV Disease
- GI ulcers/periodontal disease
- Reproductive effects
- Eye disorders
- Richard Carmona, Surgeon General of the US, Surgeon General Report, May 2004
- Case Study and Stakeholders
- 8. The Challenge
- Seized the opportunity
- Meeting with Austin Heart, PA Chief Operating Officer
- Presented the challenge
- Asked what protocol was used for tobacco users
- Prepared for the meeting
- 9. Tobacco Use and Heart Disease Statistics
- As many as 30 percent of all deaths in the United States each year from heart attack are attributable to cigarette smoking (2)
- Smoking-caused heart disease results in more deaths per year than smoking-caused lung cancer (4)
- Tobacco use increases blood pressure and risk of stroke (1)
- Women who smoke and use oral contraceptives greatly increase their risk of heart attack and stroke (4)
- Smokers risk of a heart attack is two to four times greater than that of non-smokers (3)
- 1. American Heart Association, Inc., Cigarette Smoking and Cardiovascular Disease, July 18, 2005
- 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
- American Heart Association, Inc., Risk Factors and Coronary Heart Disease, July 18, 2005
- 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
- 10. Austin Heart, PA
- 47 physicians provide care at 13 Central Texas office locations 8 counties
- comprehensive range of services include prevention , general cardiology, vascular care , electrophysiology, and interventional cardiovascular services.
- 11. Article from Austin Heart Newsletter Feb 2009
- Smoking Remains the No 1 Cause of Preventable Death in the United States
- Did you know that cigarette smokers are two to four times
- more likely to develop coronary heart disease than nonsmokers.
- Smokers are also more than 10 times as likely as
- nonsmokers to develop peripheral artery disease. After one
- year off of cigarettes the excess risk of coronary heart
- disease caused by smoking is reduced by half. 15 years
- after quitting, the risk is similar to that for people who have never smoked.
- 12. The Meeting
- Responded with information and orientation to service after learning about the practice
- Met with Medical Director
- Offered educational materials and briefing on American Cancer Society Quitline .
- Offered Professional Education
- 13. Healthcare Professional Ed
- Provided Provider and Nursing education as well as patient materials for 13 locations.
- Involved appropriate level of professionals
- 14. Tobacco half the problem
- Only 70% of primary care physicians ask their patients if they use tobacco.
- Only 40% take action.
- 15. Providing Appropriate Tobacco Cessation Assistance is Important
- 70% of smokers want to quit.
- 93% of smokers who try to quit resume regular smoking within one year.
- Five to seven attempts are usually required to succeed.
- 16. CDC Recommendations
- Tobacco dependence is a chronic condition that requires repeated interventions
- Every patient should be offered a treatment
- Patients willing to try to quit-should be offered effective treatments
- Patients unwilling to try to quit-should be offered a brief intervention designed to increase their motivation
- 17. Effective Tobacco Dependence Interventions
- 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.
- MMWR/Recommendations and Reports: November 10,2000/Vol. 49/No.RR-12. A report on findings.
- American Journal of Preventive Medicine.AM J Prev Med 2001:20 (2S); 16-66. A report on findings and evidence.
- 18. Austin Heart, PA
- Physicians will address smoking and quitting.
- Physicians advice to quit is an important motivator.
- Nurses and office staff will answer questions, help with resources and encourage patients.
- Patients can make an appointment with physician for smoking cessation support and resources.
- Insurance provides payment to physicians for smoking cessation interventions.
- All personnel are responsible for encouraging and promoting a healthy lifestyle.
- 19. Changes reported
- 2007 we had 4 physicians counsel 73 patients.
- 2008 we had 4 physicians counsel 96 patients.
- 2009 we had 36 physicians counsel 603 patients
- 20. Good News and Not such Good News
- Document in the EMR patients smoking status
- Documented what counseling and support services were provided.
- Documented the appropriate diagnosis codes for tobacco abuse.
- BUT have not tracked if patients have actually stopped.
- Best Practices and Resources
- 22. The Stages of Change
- Pre-contemplation: At this stage, the tobacco user is not thinking seriously about quitting right now.
- Contemplation: The tobacco user is actively thinking about quitting but is not quite ready to make a serious attempt yet.
- 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.
- Action: This is the first 6 months when the user is actively quitting.
- Maintenance: This is the period of 6 months to 5 years after quitting when the ex-user is aware of the d
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Cancer and Heart Disease, A Case for Working Collaboratively to Reduce Tobacco Use Sandra Villalaz, RN, MPH, CHES Community Manager for Health Initiatives
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