The Network

for LGBT Tobacco Control

Institute 2010: Tobacco Policy & Health Systems Change

by Scout

While some of this workshop was deep talk from state viewpoint about changing systems, they did do a great review of best strategies for how to get a health care agency to integrate routine cessation interventions. Considering I bet every community has a few LGBT friendly docs with large natural LGBT patient populations, focusing on getting these community-friendly offices to change can probably have a big impact on LGBT smoking status community-wide.

Background: Multi-state Collaborative for Health Systems Change

Who is this? It’s a group of 20 states that have partnered with national groups to pioneer better integration of cessation services into routine health care. See lots of great case studies and tools about this on their website.

How do we integrate better cessation into health care systems? Most current leading edge work is still focused on the basics: getting medical providers to do the AAR, or Ask, Advise, Refer model from the Public Health Guidelines. Referrals these days are often through fax forms to quitline, which allow nice followup contact between quitline & doc.

Entree: Best tips and tricks for getting health care providers to integrate cessation?

Note: This is a real time of change for providers, healthcare reform is going to usher in conversion to electronic health records for all soon, so it’s a great time to address tobacco use well. See some bullets on this at end.

  • Assess current tobacco intervention process (multi state collab has assessment tools on their website)
  • ID clinical and administrative champion (make sure clinical champion is high enough up ladder)
  • See if they have electronic health records for at least 2 yrs (so they’ve worked out bugs) (you can change systems without this but much harder to track change)
  • The newer AAR (Ask, Assist, Refer) intervention is good & takes less time than the old intervention (aka “5As” from the old guidelines).
  • Try to advocate for smoking assessment to be part of vital signs (taken at each visit) versus other medical info (not looked at too often). And it should be required vital sign, not optional.
  • Might not be doc taking vital signs, could be nurses, make sure you have champion there!
  • American Acad of Family Physicians and Amer Acad of Pediatrics have full Ask and Act toolkit for providers to integrate this work into their routine. Lots of templates and resources there, esp for elec health record integration.
  • Have info technology (IT) person at table from start, esp to plan to routinely circulate performance info reports (# smokers identified, # brief interventions, # referrals, by provider). Docs are competitive & like to do well!
  • Train staff, test changes (revise if needed), implement the feedback reports (see sample reports on web)
  • There is new money under healthcare reform to assist many medical practices to convert to electronic health records, I hear $44k per doc.
  • Eventually, healthcare reform changes means docs will get lower medicare and medicaid payments if they don’t have electronic health records that collect key info, like tobacco use.
  • See Federal Health IT website for details on how new electronic records need to meet “meaningful use” guidelines and for local tech support for conversions.

Bonus Tidbit: Best Tobacco Healthcare Reform Briefing Sheet

University of Wisconsin has boiled down the several thousand page Affordable Healthcare Act to 7 pages of what changes for tobacco and when those changes roll out. These folk say it’s the best summary they’ve seen, download it here.

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October 5, 2010 Posted by | Uncategorized | , , , | 1 Comment

New Policy Statement on Comprehensive Cessation Services

Many of us probably know that long ago, the federal best practice protocols for tobacco control started to call for comprehensive coverage of all cessation services by insurance companies. It’s really a no-brainer, right? I’m always a bit confused as to how the actuaries who run insurance risk profiles failed to notice the cost-benefit rewards of that one. I mean look at that new data from CA; each $5 pack of cigarettes costs the state of CA $27 in associated healthcare costs?!! (thanks Kurt for sending that out, thanks ALA for releasing that research). (see report here)

Well, nicely, we’re also seeing a growing trend of change on this point. Medicaid is now covering all cessation (read about it here) and Medicare is too (see here). Also, I’m not sure if it’s done or coming, but I know this coverage is being expanded to all federal employee insurance policies too. And 7 states currently require private insurance to cover cessation (read about it here) but more are looking to expand to this every day. So local policy change that makes a big difference could be coming to your neck of the woods soon.

And we want to help you make it happen!

So, I’m very pleased to debut the Networks’ new policy statement supporting comprehensive cessation coverage. Thanks to Gustavo for the writing. And good luck to all, may the day come soon when everyone has free and easy access to cessation!

Best,
Scout

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September 16, 2010 Posted by | Tobacco Policy | , , | 1 Comment

   

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