Transcript Sue Swartz - Consumer Demand

Treatment Delivery:
HEALTHCARE
Susan Swartz, MD, MPH
Center for Tobacco Independence
Portland, Maine
Product
Wide variety of professionals can
– Deliver social support, counseling, medications
There is significant variation
– Basic knowledge and skills, beliefs about their role
– Perception of smoking patients
Limitations
– See quitting as an event, not a process
– The encounter outcome is about the relationship
Strengths
– Professionals want to do the right thing
– Training can affect treatment use, improve outcomes
Populations
70% smokers seen by provider
– Less ‘usual care’ in groups with the highest smoking
rates: younger, male, uninsured
More provider intervention with smokers
– Younger, poorer health (Quinn et al), or ask for help
– Having a chronic condition (Thorndike et al)
– Primary care providers vs. specialists
Providers drive use of accessible treatment in ME.
– Medicaid Rx: 1996-99 rose across age/sex groups
• More Rx in age 35-55
–  Health professional referral to Quit Line
• High use among uninsured, age 45-64
Place
Acute care model
– ‘tyranny of visit’ -- for any chronic, proactive care
Competing demands
– Hours to deliver guideline recommendations
Talk Therapy in a medical model?
– 5 A’s at odds with Diagnose & Treat Paradigm
Opportunities
– Care Model: Teams, office systems
– Expand: dental, CAM professionals, hospitals, worksite
– Quality Measurement, QI ‘wave’
• Pay-for-Performance
– Communicate outside the Visit
Price
Provider perception:
– Tobacco talk creates tense encounter
– Smokers don’t really want to quit; are ‘weak’
– Smoker efforts not recognized
Smoker perception:
– Health worker will nag me (esp. pregnant)
Evidence
– Preventive care increases patient satisfaction
– Partnering improves trust, outcomes
Promotion
Promoting to Health Workers
– Must fit into their day (different, not harder)
– Seen to generate benefit, incl. short-term
– Viable approach for smokers not ready
Promoting Treatment to Patients
– Patients trust providers (>plans, >>employers)
– Need to leverage patient motivation
– Must be OK to access treatment
– Must be BETTER to access treatment
Policies
Professional
– Curriculum, requirements for licensing (ACGME)
Health Plans
– No treatment coverage - little utilization
• But coverage doesn’t guarantee use
– Diagnosis of tobacco → Won’t reimburse Visit
• New CMS benefit (brief provider intervention)
Health systems
– Quality Improvement include tobacco (2 A’s)
State programs
– Improve access to treatments
– But create disincentive to enhance coverage
No-Nag Zone
Seek the Best
Methods to Quit…
Opportunities
Help Health Workers Think Differently
– Tobacco is the problem vs. the Smoker is problem
– Partnering vs. Paternalistic
– Greater satisfaction vs. conflict
Make Treatment the Best Thing to do
– Credible [uncover the ‘black box’]
– Beneficial
– Accessible