BACKGROUND

2000 US Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence PHS Guideline recommends four evidence- based systems strategies to reduce tobacco use that pertain to hospitals and other health care settings. 1.Implement a tobacco-user identification system; 2.Provide education, resources, and feedback to promote provider interventions;

2000 US Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence Systems Strategies (Cont.) 3.Dedicate staff to provide tobacco dependence treatment and assess the delivery of this treatment in staff performance evaluations; and 4.Promote policies that support and provide tobacco dependence services (e.g., smokefree policies)

Limited Evidence on How to Promote Systems Changes to Reduce Tobacco Use Research is quite limited on methods for effectively promoting implementation of the PHS Guideline systems strategies. Evidence suggests that provider education on tobacco cessation alone has little effect on changing provider practice (Community Preventive Service Task Force, 2001) Until leadership is motivated to put new policies and systems in place that promote the treatment of tobacco use widespread changes in provider practices will be limited.

Smokefree Hospital Ground Policies: A Trend Takes Hold Momentum for smokefree hospital grounds polices has increased across the U.S. and Canada There are more than 200 hospitals that have implemented such policies (American for Nonsmoker’s Rights, 2006) Reasons for this trend likely include: –passage of stronger clean indoor air laws; –growing concern about secondhand smoke; –strengthening of quality measures on addressing tobacco use among certain patients by the Joint Commission on Accreditation of Healthcare Organizations.

CASE STUDY: UPSTATE NEW YORK a collaborative approach was successfully used to promote and achieve smokefree hospital grounds policies across upstate New York. In preparation for implementation of these new policies, hospitals have undertaken aggressive internal system changes to ensure that tobacco using patients, employees, and visitors receive appropriate support and treatment for their addiction to tobacco.

SUNY Upstate Medical University In August 2005, with the help of the University of Michigan Medical Center and the American Cancer Society, Upstate Medical University in Syracuse put a smokefree grounds policy into effect. New tobacco dependence treatment protocols were also adopted such as: –screening all patients for tobacco use at registration; –dedicating trained respiratory therapy staff to consult with tobacco using patients; –including nicotine replacement therapy as a standing order for tobacco dependent patients.

A Regional Collaborative Model for Smokefree Grounds

From Syracuse to Greater Albany Building on the Syracuse experience, a regional collaborative approach was pursued in the greater Albany New York area. On November 17, 2005, 16 hospitals announced the new partnership and the agreement to jointly go smokefree or tobacco by 1/1/07. Each hospital established a tobacco committee, which involves multiple departments, to plan for and implement the policy. Representatives from each committee meet monthly to review progress, share resources, and support one another.

Greater Capital Region Healthcare Tobacco Free Initiative Albany Medical Center Amsterdam Memorial Bassett HC - Cooperstown Bassett HC - Schoharie Bellevue Woman’s Columbia Memorial Ellis Hospital Glens Falls Hospital Albany Memorial Hospital Samaritan Hospital Saratoga Hospital Seton Health / St. Mary’s St. Mary’s Amsterdam St. Clare’s Hospital St. Peter’s Hospital Sunnyview Rehabilitation Hospital Capital District Psychiatric Center Margaretville Hospital O’Connor Hospital

Signs adopted by members of the Greater Capital Region Healthcare Tobacco Free Initiative

Regional Collaborative Model Six Steps to Smokefree Grounds 1.Find one or more facilities to take the lead and champion going smokefree collaboratively with other hospitals 2.Establish a coalition or partnership of hospitals looking at the issue 3. Identify any incentives and resources for healthcare facilities to join the smokefree initiative (bulk purchase or grant for signage, NRT, etc.)

4.On behalf of the partnership, write a letter to hospital presidents/CEOs asking each facility to commit to go smokefree by a specific date (focus on incongruence between mission and current policy, exposure to tobacco smoke, and potential costs savings when employees quit smoking). 5.Publicly announce commitments 6.Provide ongoing mutual support via collaborative meetings, trainings, etc.

RESULTS All hospitals in the Initiative are on track to be smokefree or tobacco free by 1/1/07 Most Initiative hospitals have begun implementing aspects of the PHS System Strategies to Treat Tobacco Use and Dependence (especially tobacco user identification via registration or nursing assessment)

Several other regional collaboratives in Upstate NY (Buffalo, Rochester, Utica, Southern tier) have been established with at least 6 new smokefree grounds policies implemented to date and as many as 43 pending at facilities across NY.

15 Addiction treatment facilities in the Albany, NY area have also committed to go tobacco-free on their grounds by 2/07. Although this initiative is influenced by the prospects of new state regulations on tobacco treatment, it has benefited from following a similar regional collaborative model. Tobacco dependence is being integrated into diagnosis and treatment planning at all levels of care.

Statewide, the percentage of smokers who received assistance with quitting from a health care provider increased from 38 percent in 2003 to 58 percent in The NYS Smoker’s Quitline serviced more than 100,000 calls in 2005 (up from an average of 40,000 calls/year).

Conclusion Smokefree hospital grounds policies, which hospitals and other healthcare facilities are embracing across the country, appear to be important vehicles to advance the implementation of systems level strategies in healthcare facilities recommended by the PHS Guidelines to reduce tobacco use. Research is needed to test the hypothesis that smokefree grounds policies are correlated with the implementation of PHS Guidelines.