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OA04 - Epidemiology and Prevention of Lung Cancer (ID 370)
- Event: WCLC 2016
- Type: Oral Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
OA04.03 - Preliminary Results of a Low Cost Intervention to Improve Tobacco Cessation Practices within a Large University Health System (ID 4599)
11:00 - 12:30 | Author(s): J. Tobi
Tobacco cessation is critical for both population and individual health, and especially so in the context of a lung cancer screening program. Our institution initiated formal lung caner screening in 2013. In preparation for this we audited randomly selected clinic visits to assess adherence to published tobacco cessation guidelines. Our findings in that study prompted us to initiate a systematic multi-step program to improve tobacco practices from assessing tobacco use to presribing pharmacotherapy, and referral to tobacco cessation counselors.
The project included four separate but related interventions; 1) Inviting clinic directors to send a clinic staff member of their choice for formal training in a specialize Tobacco treatment Specialist (TTS) course. 2) Generating monthly reports showng completeless of tobacco history (Current/Former/Never), pack-years recording, and (for former smokers) quit dates, use of pharmacotherapy for current smokers, and referrals for either tobacco cessation or formal lung cancer screening. 3) Providing monthly feedback to clinic directors comparing their performance to others in the project, and 4) Initiation of an electronic Best Practice Alert prompt for smokers including links to a Lung Cancer Screening Questionaire & decision aid and referral to Tobacco Counselor.
This University Health System is affiliated with over 150 satellite clinical sites. 20 sites delivering mostly adult primary care were invited to participate. Individuals from 14 sites completed TTS training. Initial assessment of tobacco use (Current/Former/Never) was excellent (>99%) across all clinical sites, including those who did not particpate in TTS training. However, pack-years were recorded on average less that 40% of the time and quit dates for former smokers were recorded less than 30% of the time at baseline. After training clinic staff in the TTS course, and regular ongoing feedback to clinical directors, we observed a significant initial increase in accurate recording of pack-years and quit dates (two points of emphasis) for all sites involved in the project, as well as referals to tobacco counselling. Over this time, unfortunately we did not detect an increase in the rate of prescription of tobacco pharmacotherapy. The There was a gradual increase in the the number of referrals for lung cancer screening Cts increased from an average of 30 per month to an average of over 70.
This project to disseminate the skills of a TTS training course to clinics within a large University Health System has led to modest improvements in overall practices and demonstrated areas where additional improvements are needed.
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