Healthy Mom, Healthy Family Wave 1 Action Period Call 4 June 16, 2021 - Ohio AAP
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Healthy Mom, Healthy Family
Wave 1
Action Period Call 4
June 16, 2021
Welcome
Thank You! • Ohio Department of Health – State Sponsor and Funder, Content Experts • Government Resource Center –Administrator, Data Support and QI Experts • March of Dimes –Implicit Network Support and Content Experts • Ohio Chapter, AAP –Implementation, Practice Support, and QI/Content Experts
Agenda • Data: Review, Discussion and Submission Updates –GRC Team • Practice Sharing and Discussion/Roll Call • Screening and Referral for Maternal Tobacco Dependence –Amy Gorenflo • QI Corner • Due Dates and Reminders • Wrap Up
Data: Review, Discussion and Submission Updates
Data Review
• Data submissions update
Month # Sites # Submissions
March 5 84
April 8 76
May 7 118
Total 9 278
6
Data Review
7
Data Review
8
Data Review
9
Data Review
10Data Review
11Data Review
12Data Reminders
• June data is due on July 6 (3rd is weekend and 5th is a holiday)
• Data can be submitted in 3 ways
– Directly into REDCap
o https://go.osu.edu/hmhfdataform
– Paper form scanned and submitted to REDCap
o https://go.osu.edu/hmhfdataupload
– Paper form faxed to Hayley (who will submit)
• Any questions on data can be directed to Hayley, Shadia, Alli, Evelyn, or Zack
13Questions?
Practice Discussion/Sharing
Roll Call and Practice Sharing
• How does your practice currently address smoking
cessation needs for families?
• Who do you refer to? Do you prescribe NRT?
• Adebowale A Adedipe MD INC • MetroHealth
• Bethesda Family Practice – Broadway Primary Care
• Beavercreek Family Medicine – Ohio City Primary Care
– Ohio City Pediatrics
• Grant Family Medicine
• Riverside Family Practice
• Lima Memorial Medical Center -
Wapakoneta
• Margaret B. Shipley Child Health Clinic
• Mercy Health Jefferson Family PracticeOhio Quit Line
Screening and Referral
for Maternal Tobacco
Dependence
Healthy Mom, Healthy Family Project
Action Period Call
June 16, 2021U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General: Consumer Guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020.
U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General: Consumer Guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020.
Ohio Prevalence Data-2019 • Current smoker (adult) 20.8% • Income less than 15K 37.2% • Less than HS degree 41.8% • Frequent poor mental health 34.8% • Persons with a disability 29.9% • Middle school-cigarette 3% • Middle school-EVP 11.9% • High school-cigarette 4.9% • High school-EVP 29.8%
Secondhand Smoke • High school 50.5% • Home-22.8% • Car-25.4% • Middle school 45.3% • Home-23.6% • Car-22.4%
The Basics
• Nicotine is primary addictive substance
• More than 7,000 chemicals in tobacco and in
tobacco smoke
• 200 are proven to be toxic
• At least 70 are known to be carcinogenic
Source: U.S. Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What
It Means to You. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.Smoking and Women
• Reproductive Issues/Pregnancy
• Earlier menopause
• Irregular menstrual cycles
• Low estrogen levels
• Increased difficulty with conception
• Higher risk of pregnancy complications
• Low birth weight
• Preterm birth
• Birth defects (cleft lip or palate)
• Brain development
• Increased SIDS riskSmoking and Women
• Respiratory
• Earlier onset of COPD than men
• Women die more often than men from COPD
• Cardiovascular
• Heart disease
• Greater risk (than men) of dying from an abdominal
aortic aneurysm
• Cancer
• More deaths from lung cancer than breast cancer
• Earlier diagnosis of lung cancerSecondhand Smoke
• Chemicals affect the brain in ways that interfere
with its regulation of infants’ breathing
• SIDS deaths show higher concentrations of nicotine
in lungs and higher levels of cotinine
• Other effects
• Ear infections
• Respiratory symptoms
• Acute lower respiratory infections, such as bronchitis and
pneumonia
• Severe and more frequent asthma attacks
U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon
General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease
Prevention and Health Promotion, Office on Smoking and Health, 2006 [accessed 2017 Feb 21].Although a majority of cigarette smokers make a quit
attempt each year, less than one-third use cessation
medications approved by the U.S. Food and Drug
Administration or behavioral counseling to support quit
attempts.
-Major Conclusion, 2020 Surgeon General
Report on Smoking CessationCommon Strategies to Treat Tobacco Dependence • Stages of Change model • 2 A’s and an R • Motivational Interviewing technique • 5 A’s Brief Cessation Counseling Intervention
2 A’s and an R ASK the client about smoking status ADVISE patient to quit smoking REFER to cessation treatment
The Art of the “Ask”
You don’t smoke, do you?
Do you smoke?
How many times a day do you use tobacco?Advise • Use personalized approach • Be strong while also being encouraging • Reinforce benefits of quitting • Discuss history of past attempts, success • Encourage use of assistance
U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General: Consumer Guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020.
Health Benefits of Quitting
20 minutes
Blood pressure, heart rate return to normal
8 hours
O2 level returns to normal;
nicotine and CO levels reduced by half
24 hours
CO is eliminated from body;
lungs begin to eliminate mucus, debris
48 hours
Nicotine eliminated from body; taste and smell improve
72 hours
Breathing is easier; bronchial tubes relax;
energy levels increase
Source: U.S. Department of Health and Human Services, The Health Benefits of Smoking Cessation: A Report of the Surgeon
General, 1990.Health Benefits of Quitting
2 to 12 weeks
Circulation improves
3 to 9 months
Lung function increases by up to 10%;
coughing, wheezing, breathing problems reduced
1 year
Heart attack risk halved
10 years
Lung cancer risk halved
15 years
Heart attack risk same as for someone who never smoked
Source: U.S. Department of Health and Human Services, The Health Benefits of Smoking Cessation: A Report of the Surgeon
General, 1990.FDA-Approved Pharmacotherapy
Over the Counter* Prescription
Medications
Nicotine patch Varenicline (Chantix)
Nicotine gum Buproprion SR
Nicotine lozenge Nicotine spray
Nicotine inhaler
*Important note: Health plans cover OTC products with a prescription
Source: Fiore MC, Jaen CR, Baker TB, et all. Treating Tobacco Use and Dependence:2008 Update. Clinical Practice Guideline.
Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.Refer • Be familiar with what’s available • Offer multiple options if possible • Develop mechanisms to track referral • Discuss medication and be sure it is available and accessible • Consider insurance coverage
Motivational Interviewing • Not judgmental, patient guided • Reflective listening • Discuss ambivalence • Meet patient where he/she is • Desire, confidence, ability, need • Elicit “change talk” • Use of scaling questions
Ohio Tobacco Quit Line
• FREE to anyone in Ohio
• Accessible by calling 1-800-QuitNow (1-800-784-8669)
• Telephonic tobacco cessation treatment
• Up to 8 weeks of nicotine replacement therapy
• Web-based services w/facilitated chat
• Text messaging (general and chronic disease)
• Provider online referral, self referral
• Fax referral available but being phased outEfficacy of Quitlines
• Research-validated best practice
• Participants are 27% more likely to quit vs. self help
• More calls/engagement=32% more likely to quit
• Use of NRT increases likelihood of quitting by 14%
when combined with telephone counseling
Stead LF, Hartmann-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of
Systematic Reviews 2013, Issue 8. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub3Quit Rates in Ohio
• Current six-month quit rate (QR)-34.5%
• Women usually have higher QR
• Pregnancy QR is 54.8%
• Higher with children in the home
• 32.8% compared to 28.7%
Strategic Research Group, Ohio Tobacco Quit Line Outcomes Report: July-December 2020. March 26, 2021.Pregnancy Protocol • Designed specifically for pregnant women • Dedicated coach model • Increased number of calls (10 vs. 5) • Monetary incentives for call completion • $20 prenatal, $30 postnatal (CVS gift card) • Follows participants up to six months after delivery, a time when relapse is common
Behavioral Health Program • Redesigned intake w/expansion of mental health data points • Increased length and number (7) of the calls • Increase and expansion in the variety of dosage and type of NRT offered (10 weeks) • Specialized treatment protocol • Customized e-mail and/or text messages
• Launched July 1, 2019 to addressing vaping and tobacco cessation • Program for youth under age 18 • Coaches trained to address teen quit needs • Five coaching sessions via live text messaging or by phone • Dedicated toll-free number (1-855-891-9989) or online chat • Teen-dedicated website at mylifemyquit.com • On-going text messages for encouragement • Certificate of program completion
Referral Mechanisms
• Active referral
– Web referral portal
• https://ohio.quitlogix.org/en-US/Just-Looking/Health-Professional/How-
to-Refer-Patients/Provider-Web-Referral
– Complete and send fax referral form
• Self referral
– Have patient call 1-800-QuitNow
– Patient can choose to complete online
enrollment and be called by a counselor
• https://ohio.quitlogix.org/en-US/Enroll-Now
44“What happens when I call…”
• Call is answered by a coach/counselor
• Caller completes intake questionnaire
• Demographics
• Smoking habits, past quit attempts
• First coaching call takes place at first call unless
callers opt out
• NRT shipped after each call (up to 4 times)
• Pregnant women must have medical release
• Schedule next callIncrease Quit Line Engagement
• Screen patient for readiness before referral
• Share what to expect when calling
• Phone number will not be identified as “Ohio
Tobacco Quit Line”
• Call will come from 800-934-4840 in Denver, CO
• Suggest that patient program number when
making the referralOhio Tobacco Quit Line-Resources
Ordering Information To order materials, send an email with item description, quantity desired and shipping address to: tobaccoprevention@odh.ohio.gov
Major Reference Documents
(click on title to go to documents)
Surgeon General Reports on Tobacco : Archive of all Surgeon General reports on
tobacco
Surgeon General Report on Smoking Cessation-2020: SG 2020 materials, including
Consumer Guide
Clinical Practice Guidelines-2008: A link to the clinical practice guidelines for the
treatment of tobacco dependence
CDC Best Practices for Comprehensive Tobacco Control Programs: Best practice
documents, including cessation and the Cessation Consumer Guide
Million Hearts Tobacco Cessation Change Package: New resource document for
tobacco cessation treatment in clinical practices
American Academy of Family Physicians Tobacco Cessation Resources: Link to tobacco
cessation resources, including a toolkit and one pagersContact Information
Amy Gorenflo
Cessation Services Program Administrator
Amy.Gorenflo@odh.ohio.gov
614-466-1717Questions?
QI Corner: Becoming a PDSA “Doer”
• Key elements of the Do stage:
– Start to implement your action plan
• Now that you have a plan, start with a small test – 1 afternoon, 1 day, 1 week
– Be sure to collect data as you go, to help you evaluate your plan in the
next phase, Study
• Use the data collection form to capture what is occurring
• Your team should also document problems, unexpected effects, and general
observations
– Your team might find it helpful to use a flowchart or office flow
diagram in this stage to capture data/occurrences as they happen
– Engage all team members in this phase – capture feedback from office
staff who are part of the process (MAs, nurses, etc.)QI Corner: Becoming a PDSA “Doer”
QI Corner: Becoming a PDSA “Doer”
Due Dates and Reminders
Mark Your Calendars
• First Data Submission:
– Data for June should be submitted by July 6, 2021
• Next Action Period Call:
– July 21, 12:00 pm
• Practice Coaching Meetings:
– Quarterly call/webinar set up one-on-one, for about 30 minutes by
July 15
– Schedule your meeting at: http://ohioaap.org/hmhfparticipant/
– If first PDSA cycle not yet complete, can be discussed during practice
callsQuestions?
Wrap-Up
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