cancer and heart disease, a case for working collaboratively

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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.
  • 4.
  • 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:
      • Cancers
      • COPD
      • Heart Disease
      • CV Disease
      • GI ulcers/periodontal disease
      • Reproductive effects
      • Eye disorders
    • Richard Carmona, Surgeon General of the US, Surgeon General Report, May 2004
  • 7.
    • 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.
  • 21.
    • 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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