Go
Conferences WPQC The Journal

Tobacco Cessation Fast Facts

July 2018

Quality Metrics and Tobacco Cessation

There are several quality metrics associated with tobacco cessation. There are three Healthcare Effectiveness Data and Information Set (HEDIS) Tobacco Measures: advising tobacco users to quit, discussing cessation strategies, and discussing cessation medications. The National Quality Forum (NQF) tobacco quality measure #0028: Screening of all patients 18 years and older for tobacco use at least once within 24 months AND providing a tobacco cessation intervention if identified as a tobacco user is used in numerous performance quality measurement programs, including: Meaningful Use; the Medicare Shared Savings Program; The Centers for Medicare and Medicaid Services (CMS) Accountable Care Organization (ACO) Program; and the Physician Quality Reporting System (PQRS). 

The Joint Commission has a measure set for inpatient tobacco use: Tobacco Use Screening [TOB-1], Tobacco Use Treatment Provided or Offered (during hospital stay) [TOB-2], and Tobacco Use Treatment Provided or Offered at Discharge [TOB-3].; Check out UW-CTRI’s hospital toolkit here

June 2018

Understanding Tobacco Use in Our Communities

According to the 2016 DHS Annual Report on Tobacco, the rate of cigarette smoking among adults in Wisconsin dropped from 21% in 2011 to 17% in 2015, still equaling almost 1 million people smoking in Wisconsin. However, as tobacco use declines throughout the general population, greater gaps form between this number and disparate populations. While the average over the general population of Wisconsin has settled at 17%, the rate of smoking in African American populations was 36% and 41% in Native American populations in 2015.

Although the proportion of high schoolers who identify themselves as current smokers dropped from 10.7% in 2014 to 8.1% in 2016, the use of “smokeless” tobacco among teens in the state has increased by 67% from 2012 to 2014. There also has been a sharp increase in usage of e-cigarettes among youth from 7.9% to 13.3% in the same time frame. This number is especially concerning given that nearly 88% of Wisconsin youth think they probably would not or definitely would not try an e-cigarette if it did not have any flavor such as mint, candy, fruit, or chocolate.

Pharmacists can assist patients with quitting tobacco. Check out PSW’s Tobacco Cessation Pocket Toolkit  and continue to follow PSW’s Tobacco Cessation Initiative Fast Fact Series for more resources and information.


The Wisconsin Department of Health Services' Focus on Tobacco Aligns with PSW Initiative

In May of this 2017, the Wisconsin Department of Health Services (DHS) announced its Healthy Wisconsin Initiative, which includes reducing tobacco use as a top priority area for improving the health and lives of Wisconsin residents. According to the Healthy Wisconsin website, tobacco use results in the loss of 7,700 Wisconsin lives and amounts to more than $4.5 billion in healthcare costs to the state each year.

The Wisconsin Department of Health Services’ Tobacco Prevention and Control Program has 15 tobacco-free coalitions which span 57 of our state’s 72 counties working locally to prevent youth tobacco use, educate communities, reduce tobacco-related disparities, protect people from secondhand smoke, and treat tobacco addiction.

For a full array of provider resources to assist patients with quitting smoking and tobacco use, please visit this University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) website page.

Pharmacists can assist patients with quitting tobacco. Check out PSW’s Tobacco Cessation Pocket Toolkit  and continue to follow PSW’s Tobacco Cessation Initiative Fast Fact Series for more resources and information.


May 2018

Smoking Cessation Can Be Contagious

As the prevalence of smoking has declined in the United States over the last few decades, a network analysis of the Framingham Heart Study participants sought to understand the extent to which social networks influenced individual’s smoking behavior. They found groups of widely connected people quit tobacco together, reflecting the power of social networks and peers on changing an individual’s smoking behavior. Smoking cessation by a spouse, sibling, or a friend decreased a person’s chances of smoking by 67%, 25% and 36% respectively. One suggestion for pharmacists when consulting patients on smoking cessation is to ask about their support system and if anyone is willing to quit with them.

Motivational Interviewing and Tobacco Cessation

Motivational interviewing (MI) is a behavioral counseling technique that focuses on helping patients explore and resolve ambivalence about changing their behavior. A 2015 Cochrane Systematic Review found that motivational interviewing may be useful in assisting patients with a tobacco quit attempt. The review included more than 16,000 patients from 28 randomized controlled trials where patients had between one and six sessions of MI, and MI was found to be significantly superior to brief advice or usual care. While none of the included trials had MI performed by pharmacists, the US Department of Public Health Services guideline recommends that all clinicians should provide smoking cessation interventions. For more information on how to incorporate motivational interviewing techniques for smoking cessation into your practice, check out the PSW Tobacco Cessation Clinical Pocket Toolkit and Implementation toolkit. The University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) has several Motivational Interviewing resources.


April 2018

State Approaches to Engaging Pharmacists in Providing Tobacco Cessation Medications

As the negative public health effects of smoking and other tobacco use have become more and more evident, some states are working to include pharmacists in their efforts to increase access to tobacco cessation efforts for their residents. There is a large body of evidence  that demonstrates that pharmacists are effective at helping patients quit tobacco, and the US Public Health Service Guidelines on Treating Tobacco Use and Dependence recommend that pharmacotherapy be encouraged for all patients who wish to quit smoking unless medically contraindicated. Three states (California, New Mexico and Oregon) currently have state-wide protocols that allow pharmacists to provide these medications. Arizona and Maine grant pharmacists the authority to prescribe nicotine replacement therapy in their definition of pharmacy practice and a Colorado Board of Pharmacy work group is currently developing a state wide smoking cessation workgroup.

Collaborative Practice Agreements for Tobacco Cessation

PSW championed legislation to enable Wisconsin pharmacists to accept any patient care service delegated to them by a physician since 2013. This has enabled pharmacists to expand their scope of practice in a variety of different practice settings and with various disease states, including asthma, anticoagulation and hypertension. PSW has a collaborative practice agreements implementation toolkit and the appendix includes collaborative practice agreements templates, including the newly developed tobacco cessation template. Pharmacists can download the template and use it as a basis for starting a collaborative practice agreement with a physician colleague. Also available is the PSW Tobacco Cessation Clinical Pocket Toolkit  that contains helpful clinical tips that pharmacists can use when assisting their patients in a quit attempt.


March 2018

Billing for Tobacco Cessation Services

Private payer billing codes for tobacco cessation services include CPT 99406 (intermediate smoking and tobacco-use cessation counseling visit between 3 and 10 minutes) and CPT 99407 (intensive smoking and tobacco-use cessation counseling visit, more than 10 minutes). Billing for Wisconsin Medicaid patients who receive tobacco cessation treatment is done using CPT 99201-99205 (new patients) and CPT 99211-99215 (established patients). More information can be found on the University of Wisconsin Center for Tobacco Research and Intervention’s website. The PSW Tobacco Cessation Advisory Group (TCAG) is currently exploring options for reimbursement advocacy for pharmacists.

Smoking Rates: Where Does Wisconsin Rank?

In 2016, Wisconsin was ranked 23 in the United States for adult smoking rates. That year, 17.3% of Wisconsinites were tobacco smokers, which was defined as adults who reported smoking at least 100 cigarettes in their lifetime and currently smoke every day or some days. Subpopulations with smoking rates that were higher in Wisconsin than the United States as a whole included those who identified as Black (31%) and Native Americans (23%) as well as with an annual income of $50,000 or more (12.0%). Additionally, 11.3% of pregnant women in Wisconsin smoke. With smoking rates like these, pharmacists can serve as easily accessible resources to help their patients quit smoking.



February 2018

Tobacco Cessation Medications and Insurance Coverage

There are currently seven Food and Drug Administration (FDA) –approved medications for tobacco cessation: five forms of nicotine replacement therapy (NRT), and two non-nicotine -bupropion SR and varenicline. The five forms of NRT include gum, lozenge, patch, nasal spray, and inhaler. The 2008 update to the US Department of Health and Human Services Treating Tobacco Use and Dependence guidelines recommend the use of pharmacotherapy by patients attempting to quit smoking unless medically contraindicated. The guidelines also state that there is insufficient evidence that pharmacotherapy is effective for light smokers or users of smokeless tobacco as well as pregnant women and adolescents. The University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) has a one-page summary of the 7 FDA-approved tobacco cessation medications, including dosing and contraindications.

Information on Medicaid/Badgercare and Medicare coverage for tobacco cessation medications can be found here and here.

The Wisconsin Tobacco Quit Line (800-QUIT-NOW) offers tobacco cessation telephone counseling and two weeks of free nicotine replacement therapy patch, gum, or lozenge via mail.

Pharmacists can use PSW’s collaborative practice agreement template for tobacco cessation (link: INSERT LINK) to prescribe these therapies under delegation so that their medications for quitting will be covered.

Medicaid and Medicare cover OTC medications as well as those available by prescription only. The Wisconsin Tobacco Quit Line is not able to provide specific information on an individual caller’s health insurance coverage, unfortunately. 

Pharmacists will be able to use PSW's collaborative practice agreement template for tobacco cessation to prescribe these therapies under delegation so that their medications for quitting will be covered. Stay tuned for the launch of the template!


Tobacco Use Screening Tools

The 2008 US Public Health Service Clinical Practice Guidelines for treating tobacco use and dependence notes clinician intervention in tobacco cessation increases proportionately to the rate of identification of smokers. These guidelines recommend that all clinicians ask every patient about their tobacco status at every visit, and suggest using Ask, Advise, and Assess from the “5 A” brief intervention model. The partnership for a tobacco-free Maine suggests engaging patients in a brief conversation where you ask patients about their current and recent (previous 6 months) tobacco history as well as information about if and how they have ever tried to quit before. Other screening tools include the Fagerstrom Tolerance Questionnaire and the Readiness to Quit Ladder.     

Pharmacists can assist patients with quitting tobacco by referring them to the free, 24/7 services of the Wisconsin Tobacco Quit Line (800-QUIT-NOW). Check out PSW’s Tobacco Cessation Pocket Toolkit for other supportive interventions.


Vaping Can Lead Teens to Smoking

According to an article in the New York Times , many teens may think that e-cigarettes are a safer alternative to traditional cigarettes, but many of them still contain nicotine and can be very addictive. A report by the National Academies of Sciences, Engineering, and Medicine concluded that teens who use e-cigarettes may be at a higher risk of smoking. It also important to keep in mind the unknown safety of these devices, as there are no long-term scientific studies on their addictive potential or effects on the heart, lungs, or on reproduction. 


December 2017

JUUL - New Vaping Device Appeals to Younger Target Audience

JUUL is the new popular vaping device showing up in high schools and colleges all over the US. The vaporizer is designed to look like a USB flash drive with removable parts that can be charged when plugged into a laptop. Like other vaporizers, there are options for fun flavors such as mango, crème brulee, and fruit medley as well as pods with concentrated amounts of nicotine. While vaping is not a new trend, JUUL not only has a sleek design, it is also accessible to younger audiences. A starter pack can be purchased online for only $49.99 and while it does require age and ID verification, buyers can lie about their age and use a prepaid debit card. The low cost, easy access, and high appeal of JUUL drives its popularity – even though 20 million JUUL-related products are produced each month, most stores can barely keep the product stocked. More information can be found here


Court Orders Big Tobacco to Tell Truth Through Ad Campaign

You may see ads on major television networks and newspapers regarding the dangers of tobacco starting this weekend, but the sponsors of them may surprise you. Federal courts have ruled, after 11 years of appeals, that major tobacco companies must tell the truth. The Centers for Disease Control and Prevention (CDC) says 480,000 Americans die from cigarette use each year and tobacco use results in $170 billion in direct medical costs and $156 billion in lost productivity and now the public will be made more aware of the dangers of smoking. The Justice Department’s efforts to counter the “decades of deception” started with a racketeering lawsuit in 1999 and while the US district judge ruled in 2006, opposition from the tobacco industry has attempted to delay the inevitable. The content of the ads and the frequency are court-mandated with over 50 newspapers involved and a minimum of five ads a week for a year on NBC, ABC, and CBS. Some of the messages that will be shared are listed below and you can find out more here.

  • Cigarette companies control the impact and delivery of nicotine in many ways, including designing filters and selecting cigarette paper to maximize the ingestion of nicotine, adding ammonia to make the cigarette taste less harsh, and controlling the physical and chemical make-up of the tobacco blend.
  • When you smoke, the nicotine actually changes the brain — that's why quitting is so hard.
  • Secondhand smoke kills over 38,000 Americans each year.
  • Secondhand smoke causes lung cancer and coronary heart disease in adults who do not smoke.
  • Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, severe asthma, and reduced lung function.
  • There is no safe level of exposure to secondhand smoke.


November 2017

Court Orders Big Tobacco to Tell Truth Through Ad Campaign

You may see adds on major television networks and newspapers regarding the dangers of tobacco starting this weekend but the sponsors of them may surprise you. Federal courts have ruled after 11 years of appeals that major tobacco companies must tell the truth. The CDC says 480,000 Americans die from cigarette use each year and tobacco use results in $170 billion in direct medical costs and $156 billion in lost productivity and now the public will be made more aware of the dangers of smoking. The Justice Department’s efforts to counter the “decades of deception” started with a racketeering lawsuit in 1999 and while the US district judge ruled in 2006, opposition from the tobacco industry has attempted to delay the inevitable. The content of the ads and the frequency are court-mandated with over 50 newspapers involved and a minimum of five ads a week for a year on NBC, ABC, and CBS. Some of the messages that will be shared are listed below and you can find out more here.

  • Cigarette companies control the impact and delivery of nicotine in many ways, including designing filters and selecting cigarette paper to maximize the ingestion of nicotine, adding ammonia to make the cigarette taste less harsh, and controlling the physical and chemical make-up of the tobacco blend.
  • When you smoke, the nicotine actually changes the brain — that's why quitting is so hard.
  • Secondhand smoke kills over 38,000 Americans each year.
  • Secondhand smoke causes lung cancer and coronary heart disease in adults who do not smoke.
  • Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, severe asthma, and reduced lung function.
  • There is no safe level of exposure to secondhand smoke.


The Great American Smoke-Out

November 17th is The Great American Smoke-Out, developed by The American Cancer Society (ACS). Each year, The Great American Smoke-Out urges smokers to stop smoking for the entire day, encouraging them to quit permanently. ACS also urges non-smokers to use this day to encourage their friends and family to quit smoking, noting that quitting smoking has immediate and long-term benefits at any age. The ACS has many resources like flyers, posters, and quit cards for this event available on their website along with resources for smokers wanting to quit. ACS has also developed a guide of do’s and don’ts for people wanting to help a loved one quit such as respecting that the quitter is in charge, and to ask how you can help rather than offering advice. Once someone has made the decision to stop smoking, they can visit the ACS website for a countdown clock to their quit date and a craving stopper to distract their brain when they have a craving.


October 2017

Understanding Tobacco Use in Our Communities

According to the 2016 DHS Annual Report on Tobacco, the rate of cigarette smoking among adults in Wisconsin dropped from 21% in 2011 to 17% in 2015, still equaling almost 1 million people smoking in Wisconsin. However, as tobacco use declines throughout the general population, greater gaps form between this number and disparate populations. While the average over the general population of Wisconsin has settled at 17%, the rate of smoking in African American populations was 36% and 41% in Native American populations in 2015.

Although the proportion of high schoolers who identify themselves as current smokers dropped from 10.7% in 2014 to 8.1% in 2016, the use of “smokeless” tobacco among teens in the state has increased by 67% from 2012 to 2014. There also has been a sharp increase in usage of e-cigarettes among youth from 7.9% to 13.3% in the same time frame. This number is especially concerning given that nearly 88% of Wisconsin youth think they probably would not or definitely would not try an e-cigarette if it did not have any flavor such as mint, candy, fruit, or chocolate.

Pharmacists can assist patients with quitting tobacco. Check out PSW’s Tobacco Cessation Pocket Toolkit  and continue to follow PSW’s Tobacco Cessation Initiative Fast Fact Series for more resources and information.


September 2017

Pharmacy-based Tobacco Cessation: What’s happening in Wisconsin?

Over the next year, PSW is embarking on a tobacco cessation initiative to develop and share new educational materials and tools to assist with implementing and expanding tobacco cessation services in your pharmacy practice.

But what’s currently happening in our pharmacies? We need your help to find out! Whether you are providing services regularly or have never provided tobacco cessation services, please fill out this survey. Finding will be used to better the tools created for you.


August 2017

PSW Announces Tobacco Cessation Initiative

PSW is excited to announce the Tobacco Cessation Initiative! Over the next year, PSW will be developing and sharing new educational materials and tools to assist with implementing and expanding tobacco cessation services in your pharmacy practice. The Tobacco Cessation Initiative will also include a year-long Fast Facts series covering aspects of tobacco use, demographics, and evidence-based services for helping your patient quit tobacco.  To kick off the Initiative, an educational session at the 2017 Annual Meeting titled, Cold Turkey, E-cigarettes, Meds and More: Developing the Urge to Quit, will be presented by the UW Center for Tobacco Research and Intervention (CTRI). To register and see the entirety of the educational programming at the Annual Meeting, click here (http://www.pswi.org/Education/2017-Annual-Meeting). 

Copyright © 2018 Pharmacy Society of Wisconsin. All rights reserved.
Scroll Up