Quitting tobacco use has been described as rivaling the excruciating process of escaping heroin addiction. That's why the results of the AAFP's 2013 Office Champions Tobacco Cessation Federally Qualified Health Centers Project final report offer such promise in helping patients achieve their tobacco cessation goal.
Office Champions Project staff at Lincoln Community Health Center in Durham, N.C.
Released last month, the report outlines results from the AAFP's most recent Office Champions Tobacco Cessation Project, showing that the initiative continues to boost tobacco-cessation activities across the country.
For this most recent Office Champions project, 22 family medicine practices designated as federally qualified health centers (FQHCs) received tools and training designed to help them incorporate systems changes and integrate tobacco-cessation activities into daily office routines. As nonprofit entities that provide access to care in medically underserved areas, FQHCs tend to serve populations with high rates of tobacco use. This puts them in a unique position to impact patient health in a big way.
The Office Champions model is based on the AAFP's Ask and Act program, which encourages family physicians to ASK their patients about tobacco use and then ACT to help them quit. There is evidence that advice from a health care professional can more than double smoking cessation success rates. At the very least, broaching the topic with patients puts it on their radar screen and invites further dialogue.
- The results of the 2013 Office Champions Tobacco Cessation project revealed a dramatic increase in the documentation of patients who were offered tobacco-cessation assistance.
- All 22 participating practices finished the project, for a 100 percent completion rate.
- Pre- and post-project reviews revealed a 5.49 percent increase over baseline for tobacco status documentation and a 48.1 percent increase over baseline for cessation assistance documentation.
"We've found that if you can just get people to ask about tobacco cessation, they are increasingly likely to work toward quitting," said Julie Wood, M.D., AAFP vice president of health of the public and science and interprofessional activities, in a March 5 news release. "Office Champions has proven to be an effective approach."
The results of the 2013 Office Champions project revealed a dramatic increase in the documentation of patients who were offered tobacco-cessation assistance. Additional highlights include:
- all 22 participating practices finished the project, for a 100 percent completion rate;
- pre- and post-project reviews revealed a 5.49 percent increase over baseline for tobacco status documentation and a 48.1 percent increase over baseline for cessation assistance documentation;
- results demonstrated that the Office Champions model is critical in helping practices make systems changes to integrate tobacco cessation activities into office routines; and
- more than 91 percent of participating practices expressed confidence in the sustainability of the systems changes implemented through this project.
AAFP program staff made three site visits to participating FQHCs in Durham, N.C.; Birmingham, Ala.; and Columbus, Ohio. The purpose of the visits was to observe each clinic's general operations, learn about the practice's challenges and successes, and encourage project staff in their efforts. The visits also allowed an opportunity for the AAFP team to witness firsthand how each clinical practice had integrated systems changes into its daily activities.
Holly Biola, M.D., M.P.H., participated in the site visit to Lincoln Community Health Center's central location in Durham and told AAFP News she saw the visit as an added value of participating in the program.
"We really appreciated the visit from AAFP staff," Biola said. "It was exactly what we needed to make us organize mid-year, and I think it pushed us to do more than perhaps we would have without the visit."
Feedback From Participants
Overall, Biola said participating in the program was interesting and rewarding. "The extra focus on what is the No. 1 most evidence-based, life-improving and -lengthening thing we can do in primary care to improve our patients' health was helpful in lots of ways," she noted. "This helped us to look at our processes and determine where we could make sure this counseling happened. It helped us to realize that our providers were not documenting their smoking cessation counseling in a capturable or consistent way. It also spurred us to review the evidence on what works in tobacco cessation and how to access these tools/prescriptions for our patients."
According to Biola, the Office Champions model led to cross-clinic teamwork in the Lincoln Community Health Center office.
"I was impressed with how our whole clinic (the central location) pulled together on this," she said. "Our pharmacy staff ran some numbers for us to show which providers' patients were filling prescriptions for tobacco-cessation products. They also did some informational sessions at staff meetings about what products are available at our pharmacy and what the indications, contraindications and prescribing instructions are for those products. Physicians and midlevel providers have tried to change their documentation of their tobacco-cessation counseling so we can collect the data regarding when they are doing this."
Niambi Lavender, M.A., who served as Office Champion for the West End Medical Centers Inc. location in Atlanta, said not only did her office see great success participating in the program, but she had a personal connection driving her passion in the fight for smoking cessation, as well.
"Most of our patients are smokers with either hypertension or diabetes," Lavender told AAFP News. "I took the project really seriously because I have a relative who is currently dying from lung cancer. It was personal to me that I improve the smoking rate of each of our patients. I counseled the patients. I called to check on the patients every week. I invited patients in to speak to each other about their experiences. I went out to pharmacies in the community to find the least expensive (medication) that was effective for treatment. We made drugs affordable to our sliding-fee-scale patients."
Lavender said that she would encourage every office in America to participate in Office Champions. "Saving lives and preventing cancer and heart disease should be the focus (of every clinical practice), especially in the inner city," she added.
The Office Champions Tobacco Cessation FQHC project was supported by Pfizer Inc in collaboration with the Smoking Cessation Leadership Center.
Part of the Solution
The Office Champions report comes at an important time in tobacco control history.
Jan. 11 marked the 50th anniversary of the first surgeon general's report on smoking and health(profiles.nlm.nih.gov). The 1964 landmark report, released by Surgeon General Luther Terry, M.D., was the first federal government report to link smoking to adverse health consequences, including lung cancer and heart disease.
In the past five decades, some three dozen surgeon general's reports on smoking and tobacco use have been released. The 2014 report, dubbed The Health Consequences of Smoking--50 Years of Progress(www.surgeongeneral.gov), highlights half a century of progress in tobacco control and prevention, presenting new data on the health consequences of tobacco use and introducing initiatives that can potentially end the tobacco use epidemic in the United States.
Then, on Feb. 5, CVS Caremark announced it would stop selling cigarettes and other tobacco products at its more than 7,600 CVS/pharmacy stores across the United States. It is the first national pharmacy chain to do so.
"Ending the sale of cigarettes and tobacco products at CVS/pharmacy is the right thing for us to do for our customers and our company to help people on their path to better health," said Larry Merlo, president and CEO of CVS Caremark, in a news release(info.cvscaremark.com). "Put simply, the sale of tobacco products is inconsistent with our purpose."
Long a proponent of ending the sale of tobacco products in retail pharmacies and other facilities that provide health care products and services, the AAFP applauded CVS Caremark's decision, noting that, "CVS' bold move to halt tobacco sales sets an example we hope other companies will soon follow."
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