AAFP Office Champions Leading
Tobacco Cessation in FQHCs
Family Health Centers of Georgia, Inc.
Theresa Jacobs, M.D. , FAAFP
Niambi Lavender, Medical Assistant
5/19/14
Disclosure
• The American Academy of Family
Physicians (AAFP) Office Champions
Tobacco Cessation Federally Qualified
Health Center (FQHC) Project was funded
by Pfizer Inc, in collaboration with the
Smoking Cessation Leadership Center
(SCLC)
2
AAFP Office Champions Tobacco
Cessation Project
• AAFP recruited FQHCs to participate in the
Office Champions Tobacco Cessation
Project. An FQHC is a non-profit private or
public entity that serves medically
underserved populations and/or areas
3
What is Office Champions?
A team-focused quality improvement model
that incorporates practical, proven strategies:
• Develop an implementation plan
• Provide training and improve staff
collaboration
• Initiate systems changes
• Increase patient engagement
• Evaluate results (chart reviews and surveys)
4
AAFP Tobacco Cessation Resources
http://www.aafp.org/patient-care/publichealth/tobacco-cessation/ask-act.html
5
Burden of Tobacco Use
The annual burden of smoking-attributable
mortality in the U.S. is currently estimated to
be 480,000. Millions more are living with
smoking-related diseases
6
National Uniform Data System &
Office Champions Outcomes
120
96.1
100
80
60
85.6
79.5
74.5
52.7
57.6
% Tobacco Use
Screening
% Tobacco Intervention
40
20
0
National UDS National UDS
2011
2012
7
Office
Champions
2013
Who We Are
• Family Health Centers of Georgia, Inc.
(FHCGA) began providing comprehensive
preventive healthcare in 1976.There are
eight locations in Fulton and Cobb counties.
Healthcare services include medical,
behavioral health, and dental care
8
Behavioral Health Services
• FHCGA has a licensed clinical social worker
on staff that counsels patients, as needed.
All patients 13 and older are screened for
depression and referred to behavioral
health for in-house counseling
9
Behavioral Health & Tobacco
Cessation
• More that 1 in 3 adults (36%) with a mental
illness smoke cigarettes, compared with
about 1 in 5 adults (21%) with no mental
illness
• The most common behavioral health issues
linked to nicotine dependence at FHCGA is
stress, depression, and anxiety
10
Clinical Environment
• More than 40% of FQHC patients use
tobacco, double the national prevalence
rate
• Health disparities that impact the FHCGA
community are: race, low socioeconomic
status, lack of insurance, low education
levels, and unemployment
11
Office Champion & Physician
Champion Role
Office Champion
• Provide health
education to patients
• Help develop
cessation plans based
on health risks
• Monitored patient
progress
12
Physician Champion
• Identify cessation
modality
• Refer patient to
behavioral health
counseling
• Provide patients with
treatment options
Team Approach
In order for Office Champions to be
successful, the practice team must
collaborate to meet the common goal of
achieving a tobacco-free culture
• Effective communication
• Staff buy-in
• Office & Physician Champions
sharing a leadership role
13
Systems Changes
• The AAFP Office Champions FQHC project
was instrumental in improving clinical
practice patterns at FHCGA. The goal was
to incorporate cessation into routine
workflow and reduce smoking prevalence
by 10-20%
14
1) Implementation Plan: Referrals
• Patients were referred to behavioral health
counselors, case managers, social workers,
health educators, and quitlines as needed.
In addition, the head pharmacist is a
tobacco cessation treatment specialist
15
2) Implementation Plan:
Staff Communication/Education
• Several health education classes were
made available to patients. Workshops
offered included the Office Champion as a
speaker and offered a table to display with
AAFP’s Ask and Act patient education
materials and resources to promote tobacco
cessation
16
3) Implementation Plan: Marketing
• AAFP’s Ask and Act resources including
patient education materials, flyers, posters,
lapel pins, newsletters, etc. helped to
encourage a culture of tobacco cessation
17
Tobacco Cessation 2013 rates at
FHCGA
• 1,133 patients were enrolled in the tobacco
cessation program, 30% of the patients
enrolled have reduced cigarettes intake to
less than 5 per day, 20% of patients no
longer smoke
18
Challenges
The barriers that were identified while
implementing the changes:
• Finding affordable medication for the
patients on an individual basis
• Working on prior authorization from the
insurance companies to use approved
medications
• Patients that have relapse due to life
changes
19
Successes!
• FHCGA has initiated a comprehensive
tobacco cessation program because
tobacco use screening and intervention is
extremely effective in both cost and health
outcomes
20
Patient Centered Medical Home
• FHCGA, whose framework is based on the
Patient Centered Medical Home (PCMH),
has incorporated tobacco cessation into the
workflow
• The changes made are sustainable, and
now are part of the system to support a
tobacco-free culture
21
Achieving Goals
• By participating in AAFP’s Office
Champions project, FHCGA achieved its
goal to incorporate cessation into routine
workflow and reduced smokers by 10-20%.
For more information on Ask and Act and final report results visit:
www.aafp.org/askandact/officechampions
http://www.aafp.org/dam/AAFP/documents/patient_care/tobacco/officechampions-final-report-2013.pdf
22
23
Thank You! Questions ?
Theresa Jacobs, M.D., FAAFP
trjacobs1@yahoo.com
Niambi Lavender, Medical Assistant
nlavender@att.net
Christy Alexander, MPH
American Academy of Family Physicians
Project Specialist
TempPR@aafp.org
913-906-6000 x 3140
24