OCTOBER 2019
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Partnering with a specialty clinic to help Alaskans quit tobacco use and improve heart health
The percentage of adults who smoke cigarettes has been dropping for decades, but about one in five Alaska adults still smoke. That’s higher than the national average: one out of seven. Tobacco use remains a leading cause of death in Alaska, and about 700 people die each year as a result. Most of them die from heart disease and stroke.
Helping people quit tobacco is one of the main goals of Alaska’s Tobacco Prevention and Control (TPC) Program. Two out of three adult smokers say they want to quit, and more than half have tried to quit in the past year. The program provides supportive services, including free nicotine patches, lozenges and/or gum, as well as counseling through Alaska's Tobacco Quit Line. All counseling services are free and available through phone, online or texting 24 hours a day, seven days a week. The quit coaches who provide counseling receive specialized training in Alaska Native culture.
TPC started a special pilot this year to ensure more Alaskans know about these free services, especially adults who face higher chances of tobacco-related diseases and death. Through this pilot, TPC is working with the Alaska Heart and Vascular Institute to ensure tobacco use is discussed with every patient and referrals are made to the Quit Line as needed. The Institute is a specialty clinic for cardiovascular care, providing about 90% of this type of care that’s delivered in Alaska. Despite their cardiovascular risks, this clinic’s patients report a slightly higher percentage of tobacco use than the overall percentage reported for adults statewide.
About the pilot
Alaska’s TPC started the pilot project knowing that health care providers play an important role in helping their patients quit tobacco use. Providers can help their patients successfully quit when they routinely ask patients about tobacco use, give brief advice to quit as needed, and refer patients to effective resources for support, such as the Quit Line. Providers, however, face hurdles when considering these discussions:
- Providers are addressing complex issues in a limited amount of time, so it can be difficult to make time to offer advice on quitting tobacco use.
- Patients may not follow up and make the call to the Quit Line. Experience shows that the combination of Quit Line counseling and nicotine replacement patches, lozenges or gum gives patients the best chances for successful quitting.
Through the new pilot, health care providers at the Heart Institute started using an improved model for providers’ advice to quit tobacco use, called “Ask-Advise-Connect.” This intervention includes a fax referral to the Quit Line. This allows the Quit Line staff to contact the patient, rather than relying on patients to make the initial contact.
Working together to implement the pilot
The Heart Institute delivered the “Ask-Advise-Connect” intervention during 2018 and 2019. Alaska’s TPC provided training and materials to support the interventions, as well as education about the free Quit Line services. The program helped negotiate procedures so the Institute’s providers could directly refer patients to the Quit Line, provided monthly Quit Line reports for feedback, and met regularly to help find problems early and address them.
During the pilot, the Institute provided staff time for receiving training and performing quality improvement on a quick turnaround. This included improving the reporting of patient experiences during the pilot project. The specialty clinic changed its processes to ensure patients were screened for tobacco use before seeing providers. This allowed providers to advise patients to quit tobacco use and recommend the Quit Line. The clinic’s staff also changed its Electronic Medical Record systems to automate referral to the Quit Line, including authorization for nicotine replacement therapy when appropriate.
Sharing results
The pilot between TPC and the Heart Institute increased screening for tobacco use, as well as referrals to the Quit Line. The Institute reported the following successes during the first seven months of the pilot:
- Screened and counseled 100% of patients using tobacco
- Referred 150 patients to Alaska’s Tobacco Quit Line
- Reported that one-third of those referred made an attempt to quit tobacco use
“It’s something that Alaska Heart is really proud of,” said Dr. Gene Quinn, the Institute’s Quality Improvement Medical Director. “It’s been a big win for us, and for population health.”
Dr. Quinn said patients were receptive to their physician’s advice to quit tobacco use, and providers appreciated having a trusted resource to which they could refer their patients. Alaska’s TPC found that patients were more likely to make a quit attempt if a provider made a fax referral to the Quit Line and explained what that service would offer, rather than the provider only giving the phone number for the Quit Line in hopes that the patient would make the call.
The Institute continues to implement the “Ask-Advise-Connect” model, and TPC is interested in starting similar partnerships with other Alaska clinics. For more information about this pilot project and Alaska’s Tobacco Prevention and Control program, watch this short video or contact program manager Cheley Grigsby at michele.grigsby@alaska.gov or (907) 269-8895. |
