2. The Maine Treatment Initiative A Comprehensive and Coordinated Program Susan H. Swartz, MD, MPH Center For Tobacco Independence December 10, 2003

3. Adult Smoking Rates, 1990-2002 Maine and U.S. Maine U.S. Percent Smoking

4. Maine Smoking by Age, Pregnancy BRFSS 2000 / PRAMS 1999 Percent Smoking PregnantAge Cohort

5. FUND for Healthy Maine Master Settlement Revenue Public Law established 1999 90% Health-related programs Home services, Substance Abuse, Oral Health, Rx for Elderly, School Health Trust Fund (initially) Top state using $ for tobacco control

6. Tobacco Control in Maine Partnership For A Tobacco-Free Maine (PTM) Community Grants Tobacco Treatment Initiative Media and Promotion Youth Access Surveillance and Evaluation Bureau of Health program since 1997

7. Statewide Focus Healthy Maine Partnerships 31 Community/School Grantees Focus: tobacco, exercise and nutrition Advocacy Efforts 1999Smoke-Free Restaurants 2003Smoke-Free Bars/Taverns

8. Tobacco Treatment Initiative Mission: Ensure statewide access to effective treatments

9. Effective Treatments Behavioral Counseling Nicotine Replacement Therapy Brief Messages by Health Professionals Intensive Interventions by Professionals Insurance Benefits

10. PTM Treatment Components Maine Tobacco HelpLine Medication Voucher Program Tobacco Treatment Training

11. Telephone Counseling / NRT Social Support Health Professionals and Community Tobacco Specialists Clinical Outreach Treatment Basics Training Certification (A.L.A.) Treatment Specialist Training Medication Vouchers HelpLine CounselingMedications

13. HelpLine Services For any Maine resident Ready to Quit 30 days Specialist 4 counseling sessions total Not Ready to Quit now – materials In Maine, Monday – Saturday

14. HelpLine Team Center for Tobacco Independence Oversight, management Center for Health Promotion License software and materials Intellicare Call center telephony, computer support Goold Health Services Pharmacy benefit manager (PBM)

16. HelpLine Fax Referral for Pregnant Smokers Prenatal Care providers Materials & Video Fax Referral to HelpLine HelpLine calls the woman EMW T-shirt; silver necklace

17. Evaluation of Services Who Calls - demographic, geography Trends Over Time Use of NRT Medication Quit Rate - 6 months Satisfaction – 3 months

18. Maine Tobacco HelpLine - Callers Assisted by Month August 2001 through September 2003 200120022003 3% of Maine’s adult smokers

19. HelpLine Callers 90% of callers are tobacco users 90% speak to a Specialist 30.4% have no insurance 21.6% are Medicaid recipients

20. 27% 21% 16% 37% Adult smokers from each region Maine HelpLine - Statewide Geographic REACH FY03 (7/02-6/03) Smokers Calling by Region North/East27% Western17% Mid-state25% Southern31%

21. Maine HelpLine - Demographic Reach Smokers in Maine*HelpLine Callers 18 - 24 years16%13% 25 - 40 years38%31% 41 - 60 years36%46% > 60 years10%10% Women51%57% Less than High School19%13% High School45%49% More than High School36%38% * 2000 Behavioral Risk Factor Survey

23. Medication Voucher Program Uninsured or no medication benefit Willing to have proactive calls Nicotine patch & gum - 8 weeks Current access through HelpLine Now expanding to community sites

24. RX: Paperless Program 4 weeks of NRT per Voucher Caller identifies a Maine pharmacy Electronic submission to PBM PBM calls pharmacy Second Voucher requires another contact PBM = pharmacy benefit manager

25. Medication Voucher Use 50% of callers counseled get a Voucher 96% pick up medications 47% obtain a second month of Rx NRT: Patch89% Gum11%

26. Insurance of Voucher Users No Insurance36% Commercial50% Medicare10% Medicaid<3% Unknown<2%

27. Tobacco Treatment Training Basic Training Instructor Training Clinical Outreach Specialist Training N.O.T. Training (A.L.A. Maine)

28. Basic Training 1-day conference Delivered across the state Teams of Instructors Targets: school, health, public health Aim: know about brief intervention

29. Tobacco Specialist Certification American Lung Association of Maine Certification Commission Training Written Test Written Case Commission Review Hours Required

30. Clinical Outreach Academic Detailing Model Consultants in 3 regions Target: clinicians and staff Focus Treat tobacco as chronic disorder Deliver positive messages - offer support Make office system changes Use available resources

32. Coordination of Programs - Internally HelpLine is at Center for Tobacco Independence Clinical Outreach staff attend trainings, observe HelpLine, work with Community grantees HelpLine staff present at Specialist Training Voucher access through Specialists (in progress) Relative ease of data and information access Scientific Advisory Group

33. Coordination of Programs - Externally Small state - able to work closely with the Bureau of Health, contractors, Medicaid Collaborate with strong advocacy groups - Maine Coalition on Smoking or Health, Amer. Lung Assoc. Foster change within MaineHealth (our system) Leverage expertise for funding RWJF Smoke Free Families Demonstration project American Legacy Foundation - Pediatric Detailing

34. Reimbursement for Tobacco Specialists Raising Patient Demand for services More effective Clinical Outreach Ensuring quality tobacco intervention with other state programs Maine Cardiovascular Health Substance Abuse Mental Health Challenges

35. www/tobaccofreemaine.org