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Tobacco use continues to be the leading cause of preventable death and disease,
killing about 450,000 in the US every year.
Clinicians can make a difference with even a minimal (less than 3 minutes)
intervention. In fact, there is growing evidence that smokers who receive clinician
advice and assistance with quitting report greater satisfaction with their health care
than those who do not. According to the updated Clinical Practice Guideline, brief
interventions are clinically effective and cost effective. Brief advice from a clinician
yielded a 66% increase in successful quit rates. They will listen to you!
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The Call it Quits Referral Program allows providers to easily refer any adult patient
who lives in Minnesota to the appropriate existing quitline by using a single form.
The key message: ALL MINNESOTA ADULTS have access to FREE behavioral
support through telephone counseling programs.
The program is supported by the Minnesota Tobacco Quitlines collaboration. The
purpose of this collaboration is creating tools/systems for Providers using existing
resources to increase utilization of tobacco cessation resources.
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Research shows that it takes a person several attempts to quit, and very few people
are successful at quitting or staying quit.
With support such as a quitline, however, nearly 1 in 3 will succeed in quitting and
staying quit.
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The Call it Quits Referral Program is based on the U.S. Department of Health and
Human Services’ clinical practice guideline “Treating Tobacco Use and
Dependence, 2008 Update,” * which recommends the 5 A’s model as a simple
approach to tobacco treatment. The 5 A’s are also consistent with the current
recommendations by the Natl Cancer Institute and the AMA as well as others
(although they may be in a different order).
*U.S. Department of Health and Human Services, Public Health Service, May 2008.
Accessed January 13, 2012, at
http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf
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ASK: It’s important to ask every patient at every visit about his or her tobacco use
and document it just like any other vital sign. Using the term “tobacco use” instead
of “smoking” will also include people who use other forms of tobacco, such as chew.
Tobacco dependence is a chronic condition, similar to diabetes and hypertension,
that often requires repeated intervention.
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ADVISE: Encourage your patients who use tobacco to quit.
Research shows that clinician advising results in higher quit rates.
Advice should be clear, strong and personalized.
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ASSESS: Determine if the patient is willing to make a quit attempt in the next 30
days.
Use phrases such as:
•“Are you willing to try to quit at this time? I can help you.”
•“What do you think of quitting in the next 30 days? I’d like to help you.”
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ASSIST by referring your patient to cessation phone counseling and prescribing
cessation medications. Use this time to discuss with the patient the necessary
ingredients for a successful quit attempt.
Evidence shows that counseling and quit medication together double a patient’s
chances of staying quit.
Source: U.S. Department of Health and Human Services, Public Health Service,
May 2008. Page 83. Accessed January 13, 2012, at
http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf
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ARRANGE for a follow-up phone call or site visit one week after the patient’s quit
date. Check on the patient’s compliance with medication usage.
Most relapses occur in the first 10 days.
To help prevent relapse:
Encourage continued abstinence from tobacco
Congratulate success
Discuss benefits of quitting and barriers
Use any slip-ups as teaching opportunities and as learning experiences for
the patient
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The process is simple for providers and patients alike:
1. The patient visits a provider, and the provider asks if he or she uses
tobacco.
2. If the patient says yes and is interested in quitting, the provider briefly
explains that the tobacco quitline is free and offers professionals who
give practical tips and strategies for quitting, makes follow up calls and
provides a much better chance of quitting than doing it alone.
3. The patient fills out the middle section of the referral form (or gives verbal
consent, which the provider documents in the electronic medical record
[EMR]).
4. The referral form is then faxed to a central triage number, and the
appropriate quitline contacts the patient within three days.
5. The quitline sends a follow-up fax back to the provider so he or she can
continue the conversation with the patient.
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Unlike Wisconsin and other states that have a single quitline, Minnesota has
multiple health plans, each with its own quitline service. This multiplicity of services
makes it difficult for providers to refer patients to the appropriate quitline.
The goal of this collaborative project is to make it possible and easy for providers to
refer a patient to the appropriate quitline.
What makes this project possible is its central triage system. When a site sends a
fax to the central number, the fax is forwarded to the appropriate quitline, based on
the patient’s medical insurance.
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The referral form has three sections:
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The top section is pre-populated with site information provided at the time of registration.
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The middle section is filled out by the patient (make sure this section is completely filled out before
faxing).
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The bottom section is filled out by the quitline and is faxed back to the provider for follow-up with
the patient.
Note: You may receive a different outcome form from the quitline, but all should tell you whether your
patient enrolled in phone counseling, declined services or the quitline was unable to reach the
patient.
The referral form and reporting processes are all confidential and compliant with the Health
Insurance Portability and Accountability Act (HIPAA) — including the patient’s identity and the health
plan’s identity.
IT IS IMPORTANT TO GET COMPLETE AND ACCURATE INFORMATION FROM THE PATIENT.
Three key items on the referral:
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accurate insurance (if not the correct insurance, referral needs to be re-triaged and will delay
contact with patient)
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accurate phone number and 3-hour time window to contact the patient
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‘Yes’ checked on the referral under “May we leave a message?” If ‘No’ was checked or if it was
left blank, for HIPAA reasons, the quitline will not leave a message.
It would be helpful to tell your patient to expect a call within 3-5 days and they may not recognize the
phone number. It is not a consistent number because we have several different quitlines serving
patients.
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Each referred patient who enrolls can expect:
- A series of four to five calls that are 10 to 15 minutes each
- Unlimited inbound calls
- Program materials to be mailed
- Prescription medication consultation (Quit coaches can answer general
questions about prescription quit medications, but patients will be directed to
their provider or health plan for specific benefit coverage.)
- Prescriptions for OTC quit aids to be filled. (It is best if providers write a
prescription for the OTC at the time of referral so that the patient can be
reimbursed under The Patient Protection and Affordable Care Act [PPACA]*
and not have to come back to the provider for it.)
*Note: PPACA requires OTC medicines and drugs (other than insulin) to be
prescribed in order to qualify as medical care for purposes of employer-sponsored
health plans, including Health Reimbursement Accounts, Flexible Spending
Accounts and Health Savings Accounts.
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What should the patient expect at the first phone call?
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In short, it’s quicker and more effective to refer your patient to quit services through
the Call it Quits Referral Program than to provide a single counseling session in
your office.
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The online reporting system makes monthly reports available to the clinic contact.
Reports for any given month are available around the 20h of the following month.
Data are reported in aggregate by site only (not by health plan).
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1. The successful clinic has a champion…
a. as a resource on how this program works
b. as a promoter, maintaining momentum for the program
c. for training new staff
2. The successful clinic has process, they build the referral program into their
systems and set it as an expectation for all as a part of standard processes.
3. The successful clinic gives feedback – this responsibility might fall back to the
Champion or it may be your Quality Improvement department. Someone who is
responsible for pulling the clinic reports every month to let you all know how
you’re doing.
4. The successful clinic has realistic expectations. This program has seen a
consistent overall enrollment rate of 27% which is comparable with other
recruitment methods. 100% enrollment is not attainable. Most people make
multiple quit attempts and cycle through periods of remission and relapse.
Clinicians should intervene at EVERY visit.
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