California AFP Has Key Role in Ambitious Effort to Fight Tobacco Use

The California AFP is partnering with eight other organizations in a multi-year CME initiative designed to significantly reduce the number of Americans who smoke. The initiative's primary goal is to educate at least 46,000 physicians and other health care professionals about effective ways to help patients quit. Hand-in-hand with that goal will be providing useful tools to help clinicians implement what they've learned.

Primary care physicians are a key target group for the Continuing Education Aimed at Smoking Elimination, or CEASE, initiative, which is supported by a three-year, $12 million unrestricted educational grant from Pfizer Inc.

CEASE's core curriculum is being built around the 2000 revision of the U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence. The curriculum will be modified if needed when the 2008 update to the guideline is released, which is scheduled for May. The Agency for Healthcare Research and Quality contracted with the University of Wisconsin School of Medicine and Public Health in Madison, a CEASE partner, to write the 2008 update.

"The CEASE initiative is unprecedented," said CEASE lead George Mejicano, M.D., associate dean for continuing professional development at the University of Wisconsin medical school. "More than three partners in a collaboration is rare, and we have nine. Then there's the diverse nature of the partners, bringing to the table expertise in CME, measurement, evaluation and quality.

"But most important is that we've broken the one-year funding cycle. Pfizer took a risk in funding something this big, but they knew it was the right thing to do."

Cathryn Clary, M.D., M.B.A., Pfizer's vice president of U.S. external medical affairs, said Pfizer was "enthusiastic about this type of collaboration between organizations that are working together to set a new standard on educational quality that is in the public's interest."

"I've been in CME for 17 years, and I've never seen anything like this," said Jann Balmer, Ph.D., director of CME at another CEASE partner, the University of Virginia School of Medicine in Charlottesville. "The partners put together a proposal that gives each of us the opportunity to do what we're good at doing, in a collaborative environment where everyone can benefit."

Balmer's institution is developing CEASE's online resource center for clinicians -- the gathering spot on the Internet for CEASE educational opportunities, tools and resources, with links to breaking news about tobacco and smoking issues in the larger world, as well as news from CEASE partners. Among the tools available at the resource center will be a smoking cessation software platform for use with hand-held devices. The software was developed by Scott Strayer, M.D., associate professor of family medicine and public health services at the University of Virginia medical school.

According to Mejicano, CEASE will use a "serial education" approach, reaching multiple clinicians multiple times during a three-year period to reinforce what they've learned.

He said the most innovative aspect of CEASE is the use of four different practice improvement models in order to determine their effectiveness in getting doctors to improve their practices. Other CEASE innovations include a tobacco cessation registry and an online platform that will track progress as practices participate in CEASE educational offerings on an ongoing basis.

Balmer said there also would be a Discovery Health CME television program on smoking cessation included as part of the initiative. That program currently is scheduled to air eight to 10 times beginning in June after the 2008 guideline update is released.

Mejicano called CEASE a "living initiative" because the partners will learn from their efforts. "What we release in 2008 will be modified in 2009 and 2010 as we learn," he said.

The California AFP will use one of the four practice improvement models in a 16-month practice improvement program done collaboratively with Academy chapters in Texas, Georgia, West Virginia and Ohio, said CAFP Deputy EVP Shelly Rodrigues, C.A.E. The program will teach the chronic care model -- which employs group visits, open-access scheduling and a team approach to care -- using smoking cessation as a way to incorporate the model into the practices that participate.

The CAFP also is developing the curriculum for CEASE's live CME offerings. The first live CEASE presentation will debut at CAFP's annual meeting in April. CEASE presentations also are scheduled at the meetings of 17 other AAFP chapters and several other CME meetings.

Carol Havens, M.D., of Fair Oaks, Calif., director of clinical education for Northern California Kaiser Permanente and a practicing family physician, serves on the CAFP committee that's been developing the CEASE curriculum. Although live presentations are the most traditional CME format CEASE will be using, Havens said the CEASE presentations would be anything but "business as usual."

"In the live presentations, the faculty will essentially model the process of behavior change with physicians that we expect them to do with their patients, using the 'five A's' in the tobacco use clinical practice guideline -- ask, advise, assess, assist and arrange," she explained. "We'll ask questions and get responses via an audience response system. We'll provide evidence-based information, ask physicians to commit to making changes in their practices and to set a start date, ask them what else we need to do, and arrange follow-up.

"We're really committed to providing information in a way that has the best chance of making a difference."

Tobacco addiction causes 440,000 deaths in the United States each year, and 70 percent of current U.S. smokers say they'd like to quit, noted Julie Wood, M.D., of Lee's Summit, Mo., a member of AAFP's Tobacco Cessation Advisory Committee. "We commend the California AFP and its CEASE partners for pulling together this ambitious, far-reaching effort to combat the problem, and we're glad that family medicine is playing an important role in the effort."

The AAFP's Ask and Act program also offers smoking cessation materials physicians can use in their practices. Ask and Act materials will be used in the CEASE initiative, said Rodrigues.