Transcript Learn more - American Lung Association

Basics: 2As & R Clinical Intervention
Artwork by Nancy Z. © 2010 American Aca0emy of Pediatrics (AAP)
Children's Art Contest. Support for the 2010 AAP Children's Art Contest was
from the Flight Attendant Medical Research Institute.
Objectives
• Understand and be able to implement the 2 As and an R
intervention in clinical pracitce
• Make recommendations for cessation to patients and
family members
Principles of Tobacco Dependence
Treatment
• Nicotine is addictive
• Tobacco dependence is a
chronic condition
• Effective treatments exist
• Every person who uses tobacco
should be offered treatment
Why Physicians?
• Tobacco use and smoke exposure result in adverse
health outcomes for both adults and children
• 70% of smokers see a primary care physician annually
– Only 17.3% of adults report being asked about secondhand
smoke exposure by their physician
– 27.2% of parents report being asked about secondhand
smoke exposure by children’s physician
– 63% of physicians assess patients’ willingness to quit
– 13% of physicians refer to appropriate treatment
– 17% of physicians arrange a follow-up visit to address
smoking issues
Cessation is the Goal
• Eliminate the #1 cause of preventable morbidity and
mortality
• Eliminate tobacco smoke exposure of all household
members
• Decrease economic impact
– Average cost per pack across US > $5.75
• Decrease teen smoking rates
• Eliminate smoking in future pregnancies
Smokers Want to Quit
• 70% of tobacco users report wanting to quit
• Most have made at least one quit attempt
• Tobacco users cite health expert advice as important
• Regardless of type of provider! THIS MEANS YOU!
Artwork by Aishani S. © 2013 American Academy of
Pediatrics (AAP) Children's Art Contest. Support for the
2013 AAP Children's Art Contest was from the Flight
Attendant Medical Research Institute.
But… few adults are “Ready to Quit”
in the next 30 days
• You can help these patients and/or family members as well!
– Promoting awareness of the risks of smoking to the patient and
family member, and the importance of quitting for complete
protection creates tension…
– You can recommend cessation medications and referral to state
quitline services
So What To Do?
• Ask the RIGHT questions.
• SUPPORT patients and family members in
what they are already doing to protect
their health and their family’s health, and HELP them
move them toward greater protection.
– Start from where THEY are, and not from where you want
them to be…
– We have more to offer than just telling them to quit.
– Help parents get the information to the smokers.
The 5 As
Ask about tobacco use and secondhand
smoke exposure
Advise to quit
Assess readiness to quit
Assist in quit attempt
Arrange follow-up
The 5 As
Ask
“2As & R”
Ask
Advise
Assess
Advise
Assist
Arrange
Refer
Step One: Ask
Ask patients and family members about
tobacco use and
rules about smoking in the home and car
Every year, ask patients and families:
“Does any member of the household use
tobacco?”
Step One: Ask
If the patient or family member you’re speaking with uses
tobacco.. ask if they are:
– Interested in quitting?
– Would they like a medication to help
them quit?
– Want to be enrolled in the free
quitline?
Step One: Ask
If the patient or family members you’re speaking with uses
tobacco but says NO, ask if they are:
– Interested in help to maintain a completely smoke free home
and car?
– Would they like medication to help them avoid smoking or to
reduce smoking?
Step Two: Assist
• Use the responses on Step One to guide how you assist
with addressing tobacco use.
• Ways to approach:
• “Quitting smoking is the best thing you can do to help protect
your health and the health of your family.”
• “I can help you.”
• Assess interest in quitting
• Set a quit date in the next 30 days
• Prescribe or recommend medication for assisting quit
• Enroll in Quitline
• Document services delivered to enhance complexity of
visit to level 4
Step Three: Refer
Refer families who use tobacco to outside help
• Use your state’s “fax to quit” quitline enrollment form
• Arrange follow-up with tobacco users
• Record in the patient’s medical record
But How?
• Include all the parts that make the practice run
• Staff, clinical and administrative
• Records, paper and electronic
• Rooms, hallways, waiting rooms
• Resources in the community and beyond
Be Thoughtful In Your Implementation
• Understand the current system
• Research the areas most in need of change in your
practice
• Start with the end in mind…how do you want your
system to function?
Team Involvement Is CRITICAL
• Involve your staff early!
• First meet with key staff, then invite participation by staff
at all levels
• Be sure to include:
• Front desk
• Nursing and clinical staff
• Administration
Get Input
• Brainstorm about implementation and barriers
• Invite ideas on logistics of asking and advising
• Consider developing implementation plans, using
quality improvement processes
Need more information?
American Academy of Pediatrics
Julius B. Richmond Center of Excellence
www.aap.org/richmondcenter
American Lung Association
www.lung.org/cessationta
Audience-Specific Resources
State-Specific Resources
Cessation Information
Coding & Payment Information
Tobacco Control E-mail Lists
Clinical Practice Change Resources