Helping Patients to Quit Using Tobacco

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Helping Patients to Quit Using Tobacco

• Hill Air Force Base
• Dental Clinic
• August 11, 2005
• Isa Kaluhikaua, CHES
• Davis County Health Department
• Bureau of Health Promotion
• 451-3398
• isa_at_daviscountyutah.gov

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Why are we here?

• Train dental clinicians in a proven effective
  3-minute intervention to help their tobacco using
  patients to quit.
• Provide consistent tobacco cessation information
  to all tobacco using patients.
• Introduce The TRUTH Network materials.
• Address ADHA and UDHA goals.

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Why is this my job?

• More than half of adult smokers see a dentist
  each year.
• Effects of tobacco use are visible in the mouth
  even in relatively early stages of use.
• Tobacco is the root of many oral health problems.
• Dental patients request treatments that counter
  the effects of tobacco use on their appearance.
• Most dental patients want and expect dental
  professionals to provide cessation advice.
• Brief tobacco dependence treatment is effective,
  and every patient who uses tobacco should be
  offered at least brief treatment.

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Tobacco Use Trends in Utah

• Average age of initiation - 12.5
• 60 by age 14
• 90 by age 19
• Tobacco use rate in Davis County 9.8
• Tobacco use rate at HAFB 28.
• There are more than 190,000 smokers in Utah.
• 81.5 of Utah smokers report that they would like
  to quit.

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Oral Health Problems caused by Tobacco

• Tooth-loss, jawbone loss and periodontal
  diseases.
• Impeded effectiveness of periodontal therapy,
  dental implants, and wound healing.
• Tooth decay for the tobacco-users children,
  results from exposure to secondhand smoke

• 4x the risk of developing oral cavity or
  oropharyngeal cancer, which kills 49 of its
  victims within 5 years of diagnosis.

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Success Rates of Tobacco Dependence Treatments

• No help 7-8
• Health care provider advice (lt5 minutes)
  10-12, 15 for pregnant women
• Counseling (91-300 minutes) 10-20
• NRT 15-30
• NRT Counseling (91-300 minutes) 25-35
• Zyban 25-35

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How do I help tobacco users quit?

• Even a minimal intervention, lasting less than 3
  minutes, can significantly increase overall
  tobacco abstinence rates.
• The 5 As
• ASK the patient if he or she uses tobacco
• ADVISE him or her to quit
• ASSESS willingness to make a quit attempt
• ASSIST him or her in making a quit attempt
• ARRANGE for follow-up

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How do I help tobacco users quit? cont.

• Use The TRUTH Network materials to help
• you with your 5As intervention.
• Treating Nicotine Dependence, Utahs Healthcare
  Provider Guide
• Brochures (Welcome Guide Think About It)
• Utah Quit Line Utah QuitNet
• Fax Referral Form
• Pharmacotherapy Guide

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1. ASK

• Ask EVERY patient about tobacco use status at
• EVERY visit.
• Current
• Former
• Never
• This occurs most consistently when there are
  systems in place, such as question on intake
  form, chart stickers, or electronic prompts on
  electronic medical records. Chart stickers are
  available.

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2. ADVISE

• Clinicians should urge all tobacco users to quit.
• Even brief advice to quit by a clinician results
  in greater
• quit rates. Smokers cite a clinician's advice to
  quit as an
• important motivator for attempting to stop
  smoking.
• Advice should be
• clear
• strong
• personalized
• Specific to the individual 's own situation (e.g.
  oral health
• condition, family status, costs of tobacco).

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ADVISE cont.
Nicotine Stomatitis Smokers Palate
Black, hairy tongue
Gingival recession
Gingivitis
Periodontitis, Stained teeth
Leukoplakia
Oral Cancer
I cant see what tobacco is doing to your heart,
lungs, brain and other organs, but I would like
to show you some changes in your mouth.
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3. ASSESS

• "Are you willing to try to quit at this time?"

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What if they are not willing?

• Provide patient with Think About It brochure
  from The TRUTH Network.

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4. ASSIST

• Provide patient with Welcome Guide brochure
  from The TRUTH Network.
• Discuss the quitting process.
• Set a quit date.
• Tell family and friends.
• Review past quit attempt experiences.
• Anticipate challenges.
• Remove tobacco products.
• Avoid alcohol.
• Recommend pharmacotherapy.

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Pharmacotherapy

• Use the Pharmacotherapy Guide from The TRUTH
• Network.
• Many medications have been approved by the FDA
  for smoking cessation and have been shown to
  significantly improve abstinence rates.
• They work to reduce cravings and other withdrawal
  symptoms.

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ASSIST cont.

• Would you like the Utah Tobacco Quit Line to
  help you quit?

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ASSIST cont.

• YES
• Have patient fill out the Utah Tobacco Quit Line
  Fax Referral Form.
• 1. Clinician writes name on item 1 of the form.
• 2. Patient fills out items 2-12.
• 3. The client must sign the form.

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ASSIST cont.

• NO
• If the patient does not want to fill out the
  form, give the patient the Quit Line's toll free
  telephone number (1-888-567-TRUTH) or offer a
  Utah Tobacco Quit Line card so that the patient
  can contact the Quit Line when they are ready.

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UTAH TOBACCO QUIT LINE1-888-567-TRUTH (8788)

• The Quit Line triple or quadruples quitting rates
  of Utah tobacco users.
• Free Cessation Services
• Telephone Counseling
• Quit Kits
• Referrals
• Nicotine Replacement Therapy (NRT) if eligible
  and appropriate

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UTAH QUITNET http//utahquitnet.com

• All Utah QuitNet services are available to all
• Utahns free of charge.
• Personalized quitting plans
• Quitting information
• Peer support
• Expert advice
• Pharmaceutical product support

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5. ARRANGE FOLLOW-UP

• Fax the form to the Utah Tobacco Quit Line's toll
  
• free fax number
• 1-800-483-3114
• The Utah Tobacco Quit Line faxes your clinic so
• that you know what type of services your patients
  
• received.

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Review

• Ask
• Advise
• Assess
• Assist
• Provide Welcome Guide brochure Fax Referral
  Form
• Brief discussion of quitting process
• Pharmacotherapy
• Arrange follow-up
• Fax referral form to Utah Tobacco Quit Line

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American Dental Hygienists Associations
Smoking Cessation Initiative

• Goal 50 of dental hygienists screen their
  clients regarding tobacco use by 2006
• www.askadviserefer.org

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The Current Trend
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Utah Dental Hygientists AssociationGold Card
Program
Goal One referral to Utah Tobacco Quit Line
for each hygienist.
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Tobacco Cessation Websites for Health Care
Providers

• 1. Tobacco Cessation Guideline Publications 
• http//www.surgeongeneral.gov/tobacco/default.htm
  
• Dr. Fiore's course in the 5 A's
  http//www.cme.wisc.edu/online/ctri/index.htm
• Utah Department of Health, Tobacco Prevention
  Control Program
• http//www.tobaccofreeutah.org/healthcare.html