1. A Clinical Intervention Program for Tobacco Prevention and Cessation Detroit, Michigan

2. VODI’s Goal Research, Design, and Implement a comprehensive clinical intervention program for tobacco cessation.

3. What is VODI? A Collaborative Partnership Henry Ford Health System St. John Health The Detroit Medical Center The Detroit Department of Health Federally Qualified Health Centers Political, Faith-based, and human service organizations Part of the W.K. Kellogg Community Voices Initiative

4. What does VODI do? VODI provides free or low-cost health services to the uninsured and underserved VODI focuses on primary care, pharmacy, lab, dental, care management, and pharmacy services VODI is the “medical home” for low-income, uninsured residents of Detroit

5. A bit of background… Detroit is 83% African American There is no “public health” hospital There are approximately 180,000 uninsured people in Detroit and the number served by VODI is 20,000 Detroit has 3 major universities, 2 dental schools and a community college system.

6. Who are VODI patients? live in Detroit cannot qualify for Medicaid or other public insurance programs are between the ages of 18 and 64 fall below 250% of the federal poverty level guidelines (average monthly pay rate is under $1000). the average age of a VODI client is 39 years old. Over half of VODI clients are employed.

7. The VODI Vision Time Energy Commitment Improve quality…reduce costs

8. VODI’s Tobacco Cessation Program CME Health Education Kiosks Nicotine replacement and/or pharmacotherapy Academic Detailing Tobacco Cessation Counseling

9. Continuing Medical Education: “Oral Health & Tobacco Cessation in a Primary Care Setting” CD-ROM: University of Michigan – School of Dentistry * 2 Websites Accreditation: Wayne State University and the Detroit Medical Center * 4 CME credits

10. Development of the CME Content (provider focus groups) Technical Support Medical Review Media Consultants Accreditation

11. Continuing Medical Education Identify the users Determine readiness to quit Tailor counseling based on readiness

12. CME Evaluation Pre-test and Post-test questionnaires 6-month follow-up survey More than 100 providers have been trained 100 more in the next 2-3 months

13. CME Results – Scores Pre- and Post-Session Questionnaires CME Pre-Test CME Post-Test Follow-up Total Score31%53% Pretest: During the last week, how many patients have you counseled to quit smoking/using tobacco? Mean number of patients: 7 During the last week, how many times have you recommended NRT or Zyban to assist them? Mean number:2 Follow-up: Question 1: Mean number of patients: 6 Question 2: Mean number 3

14. CME 6-Month Follow-up Did the CME contain what they needed to counsel patients? Could they counsel based on readiness to quit after the CME? Did they find the information useful?

15. Health Education Kiosks Used by over 9000 individuals Provides information on tobacco use and tips on quitting smoking. Gives us information about smoking rates and attitudes toward smoking among clinic patients.

16. The next steps to a Comprehensive Tobacco Cessation Program Free Nicotine Replacement Therapy and/or Pharmacotherapy Academic Detailing Tobacco cessation counseling and support programs

17. Academic Detailing Various levels of interaction/approvals Provider Administration Medical Director Health Care Systems

18. Academic Detailing Assessments Clinic Specific Plans Form Revisions Training Follow-up/Program Maintenance

19. Assessments What systems are in place? Do they: 1.d esignate tobacco use at each visit? 2.assess patient’s readiness to quit? 3.have any health education materials? 4.document advice given? 5.have any referral services in place?

20. Clinic Specific Plans Health Education Materials Videos, posters, banners Fliers/magnets for referrals to counseling and/or Quit Line ICD-9 Codes NRT/Zyban Cheat Cards Monthly newsletters Dinner meetings/seminars Quit smoking days at the clinics

21. Form Revisions 1. Intake/History Forms 2. Vital Signs (SVS) 3. Progress/Intervention Notes

22. Training Let staff know what has been implemented and work with them for as long as it takes Present data from CME pre-test,post-test and follow-up Present data from the kiosks Teach use of educational materials as tools for talking to patients Present research based on their clinic demographics Stress the importance of using the prescriptions properly Teach them how to refer patients with our tools

23. Follow-up/Program Maintenance Stay in close contact with the clinics Assign Champions in each clinic

24. Program Evaluation Tools ICD-9 Code 305.1: Tobacco Use Disorder Nicotine Replacement Prescriptions Medical Chart Audits Counseling/Quit Line Referrals

25. Sustainability Potential Grant Funding Development of a Business Plan to offer this program to HMO’s and private practices Providing them with materials that can be copied or ordered at no costM Implementing permanent documentation through forms

26. Contact Breaking Free Breaking Free Gayle Walters Phone: 517-546-2169 Email: gayle@creativecatalyst.com VODI Tobacco Use Reduction Project Deirdre Shires Phone: 313-832-4246 Email: dshires@med.wayne.edu CME Program: http://oralhealth.dent.umich.edu/VODI/html/00/about.html