NACCHO, District of Columbia
July 20, 2017
NACCHO, District of Columbia
July 20, 2017
The Centers for Disease Control and Prevention's (CDC’s) Tips from Former Smokers™ Campaign encourages tobacco users to quit by sharing real‐life experiences of smokers. In 2017, NACCHO partnered with the CDC to provide technical assistance to three local health departments (LHDs) and their associated healthcare providers to examine whether the placement of Tips™ materials would increase cessation conversations between providers and patients.
To accomplish this project, LHD staff worked with clinical staff to track the baseline number of healthcare provider – patient cessation conversations happening before Tips™ materials were placed into the clinics. Then, LHD staff placed Tips™ video and/or print materials (which are always free‐of‐charge from the CDC) into clinic waiting rooms, patient rooms. Clinic staff were educated on evidence‐based tobacco cessation intervention strategies (e.g. the 5As) and free tobacco cessation resources, like state QuitLines. For the next eight weeks, clinic staff tracked the number of tobacco cessation conversations occurring between patients and clinic staff. The data from each LHD demonstrates how the placement of Tips™ materials in clinical settings is an easy, low‐cost approach to increasing tobacco cessation.
The City of Sioux Falls Health Department (SFHD) serves the largest city in South Dakota (pop. 853,175). The city is experiencing rapid population growth, adding 3,000‐4,000 new residents each year. Live Well Sioux Falls is a SFHD‐based initiative designed to improve the health and well‐being of residents through regular community health assessments and collaborative solution building. The 2016 SFHD Community Health Status Report identified tobacco prevention as a major priority. SFHD found that 16.5 percent of South Dakota high school students are smokers and 11.5 percent of youth use spit/chew tobacco. Live Well Sioux Falls supports tobacco prevention by promoting smoke‐free housing and tobacco‐free worksites and promoting the South Dakota Quitline. SFHD also houses Falls Community Health, a Federally Qualified Health Center (FQHC) that provides primary medical and dental care through its main clinic and through three school ‐based clinics. Falls Community Health serves more than 13,000 patients, including a significant number of patients diagnosed with hypertension.
The successful integration of Tips™ materials into clinics requires healthcare providers to be trained on a protocol for tobacco intervention and cessation referrals. In many FQHCs, including SFHD’s Falls Community Health, staff work hard to balance the provision of high‐quality medical care with the operational and administrative demands of running a clinic. SFHD’s Live Well Sioux Falls Community Health Educators anticipated concern from clinic staff who could perceive the Tips™ intervention as additional work. To address these implementation challenges, the Community Health Educators consulted with the Falls Community Health Clinic’s leadership team to determine the best way to introduce the new strategy. Based on their feedback, the Community Health Educators developed a strategy to integrate Tips™ into the clinic setting and routine patient visits. The SFHD Community Health Educators designed a simple training for clinic staff and providers on delivering the 5As (a CDC‐recommended tobacco cessation counseling protocol), using the Tips™ materials, and making referrals to free cessation services, such as the Quitline. SFHD Community Health Educators also identified placement strategies that would make the Tips™ materials easily accessible to patients as well as clinic staff and providers. For example, flyers in patient exam rooms served as a visual reminder for staff to speak to patients about tobacco cessation and palm‐sized reference cards with Quitline information were an easy tool to use during the patients’ appointments.
During the 10‐week implementation period, the Falls Community Health Clinic saw a 163% increase in cessation conversations compared to the baseline data in April. Their in‐house FQHC healthcare provider also had a 154% increase in cessation conversations compared to baseline data for the entire month of May and last two weeks of April. Falls Community Health Clinic staff also reported that almost all of the conversations about tobacco use during patient visits were initiated by providers, indicating that providers integrated the Tips™ campaign into their routine practice. In addition to providing materials, some staff even called the Quitline with the patient from the exam room. A number of factors facilitated the adoption of the Tips™ campaign across the clinic. First, clinic staff believed Tips™ would be an effective intervention because it shared stories from real people. Second, the campaign’s emphasis on visual elements helped bridge language barriers with as patients from the Nepali community that has a high proportion of chew tobacco. Designing an implementation strategy with the needs of clinic staff and providers in mind is essential for success. In addition to facilitating the integration of a new practice into clinic flow, the test period also revealed opportunities to tailor the approach to meet the unique needs of specific sub‐populations, including the Nepalese. Falls Community Health Clinic intends to continue implementing the Tips™ campaign. SFHD Community Health Educators plan to support ongoing integration of the campaign through onsite tobacco cessation classes and provider and staff “refresher” trainings. For more information, please contact Mary Michaels at the City of Sioux Falls Health Department State at firstname.lastname@example.org