Arizona Department of Health Services - Tobacco Education and Prevention Program Proactive Referrals: Proactive Referrals: Increasing Cessation Increasing Cessation Recruitment by Building Recruitment by Building Collaborations Collaborations Pamela Powers, MPH; Robert Leischow, MPH; Mary Gilles, Pamela Powers, MPH; Robert Leischow, MPH; Mary Gilles, MD; Rebecca Ruiz-McGill; Amy Dye; MD; Rebecca Ruiz-McGill; Amy Dye; Susan Larsen; James Ranger-Moore, Ph.D. Susan Larsen; James Ranger-Moore, Ph.D. Network for Information and Counseling - Arizona Smokers’ Network for Information and Counseling - Arizona Smokers’ Helpline Helpline Mel & Enid Zuckerman Arizona College of Public Health Mel & Enid Zuckerman Arizona College of Public Health National Conference on Tobacco or Health National Conference on Tobacco or Health Boston, Mass., Dec. 11, 2003 Boston, Mass., Dec. 11, 2003
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Proactive Referrals: Increasing Cessation Recruitment by Building Collaborations
Proactive Referrals: Increasing Cessation Recruitment by Building Collaborations. Pamela Powers, MPH; Robert Leischow, MPH; Mary Gilles, MD; Rebecca Ruiz-McGill; Amy Dye; Susan Larsen; James Ranger-Moore, Ph.D. Network for Information and Counseling - Arizona Smokers’ Helpline - PowerPoint PPT Presentation
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Arizona Department of Health Services - Tobacco Education and Prevention
Program
Proactive Referrals: Proactive Referrals: Increasing Cessation Increasing Cessation Recruitment by Building Recruitment by Building CollaborationsCollaborationsPamela Powers, MPH; Robert Leischow, MPH; Mary Gilles, MD; Pamela Powers, MPH; Robert Leischow, MPH; Mary Gilles, MD;
Rebecca Ruiz-McGill; Amy Dye; Rebecca Ruiz-McGill; Amy Dye; Susan Larsen; James Ranger-Moore, Ph.D.Susan Larsen; James Ranger-Moore, Ph.D.
Network for Information and Counseling - Arizona Smokers’ Helpline Network for Information and Counseling - Arizona Smokers’ Helpline Mel & Enid Zuckerman Arizona College of Public Health Mel & Enid Zuckerman Arizona College of Public Health
National Conference on Tobacco or HealthNational Conference on Tobacco or HealthBoston, Mass., Dec. 11, 2003Boston, Mass., Dec. 11, 2003
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Tobacco Control in Tobacco Control in ArizonaArizona Comprehensive system funded by tobacco Comprehensive system funded by tobacco
tax ($1.18)tax ($1.18)– 15 Community-based tobacco control projects 15 Community-based tobacco control projects
– 11 Tribal Projects11 Tribal Projects
– Statewide Services: Helpline, Information Statewide Services: Helpline, Information Technology and Internet Services, Training and TA, Technology and Internet Services, Training and TA, Policy Tracking, Media, EvaluationPolicy Tracking, Media, Evaluation
Visit Visit www.TEPP.orgwww.TEPP.org for additional details for additional details
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Arizona Smokers’ Arizona Smokers’ HelplineHelpline Created in 1995 at the University of ArizonaCreated in 1995 at the University of Arizona Funded by ADHS/TEPP to provide: Funded by ADHS/TEPP to provide:
– Bilingual proactive telephone counselingBilingual proactive telephone counseling– Bilingual mailed self-help publicationsBilingual mailed self-help publications– Information and referral to local servicesInformation and referral to local services– Reduced cost for NRT or ZybanReduced cost for NRT or Zyban– Pre-recorded voicemail and FAX quit tipsPre-recorded voicemail and FAX quit tips– Cessation technical assistanceCessation technical assistance– www.ASHLine.orgwww.ASHLine.org with interactive with interactive
decision-making tools and E-mail decision-making tools and E-mail
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Levels of Service Based Levels of Service Based Upon Client ChoiceUpon Client Choice Questions OnlyQuestions Only Information OnlyInformation Only Information and ReferralInformation and Referral CounselingCounseling Currently QuitCurrently Quit Calling for AnotherCalling for Another
– Friend or relativeFriend or relative
– Healthcare providerHealthcare provider
– Human ResourcesHuman Resources
Arizona Department of Health Services - Tobacco Education and Prevention
Community projectsCommunity projects– Pilot project: referrals Pilot project: referrals
from Mohave County from Mohave County make up 68% of the make up 68% of the proactive community proactive community referrals (FY 01-02)referrals (FY 01-02)
WIC clinicsWIC clinics– Pilot project: recruitment Pilot project: recruitment
from Mohave County WIC from Mohave County WIC increased 340% in 3 increased 340% in 3 quartersquarters
Arizona Department of Health Services - Tobacco Education and Prevention
Gains client Gains client consent for consent for Helpline callHelpline call
Faxes referral to Faxes referral to HelplineHelpline
Helpline calls, Helpline calls, recruits client into recruits client into services, doesservices, doesintake formintake form
FAX TO: Arizona Smokers’ Helpline 1-877-908-8181 Toll-free fax number
FROM: (Stamp or write in your contact information here)
Client Consent and Personal Information Section: I understand that the Arizona Smokers’ Helpline will be contacting me with quit tobacco information, community referrals and/or counseling. My participation is voluntary. I understand that any information I provide will be kept confidential. I give the Helpline and the referring agency or physician permission to discuss my quit status.
_________________________________________ ___________________________________________ Client’s Name (please print) Client or Guardian’s Signature Verbal consent received ___________________________________________ Person obtaining verbal consent (sign and print) ___/___/___ Client Date of Birth Best time to call client: _________________________________________ Client’s Address 8am to 12pm 12pm to 5pm _________________________________ 5pm to 8:30pm Specific: _________________________________ Spanish Speaker English Speaker (_______)________________________________ Phone: home work other
Referring Agency Section: Please CHECK ALL THAT APPLY for Client: Adult Youth Youth Diversion Pregnant/post-partum WIC
Intra-Agency Section: If your agency is receiving a proactive referral, please track the client contact information below, and fax this form back to the agency that sent you this fax: __________________________ (referring agency’s fax number)
Attempt Date Time Result
1 Reached, accepted services Reached, declined services Not reached
2 Reached, accepted services Reached, declined services Not reached
3 Reached, accepted services Reached, declined services Not reached
– To create a uniform manner in which to refer clients To create a uniform manner in which to refer clients to free, research-based, quit-tobacco services.to free, research-based, quit-tobacco services.
Goals:Goals:– Increase access to services statewideIncrease access to services statewide
– Increase awareness of tobacco tax-funded servicesIncrease awareness of tobacco tax-funded services
– Create system changes within healthcareCreate system changes within healthcare
– Provide a mechanism for evaluation of productivity Provide a mechanism for evaluation of productivity and cost effectiveness of training and referral systemand cost effectiveness of training and referral system
– Decrease the prevalence of tobacco useDecrease the prevalence of tobacco use
Arizona Department of Health Services - Tobacco Education and Prevention
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Provider Advice to QuitProvider Advice to Quit
Most Americans see doctor annuallyMost Americans see doctor annually Physician advice to quit is a powerful Physician advice to quit is a powerful
motivator-- even advice as brief as 3 motivator-- even advice as brief as 3 minutes can make a differenceminutes can make a difference
5 “A’s”: every office visit, every patient5 “A’s”: every office visit, every patient– AskAsk if patient smokesif patient smokes– AssessAssess readiness to quit readiness to quit– AdviseAdvise to quit to quit– AssistAssist in quitting/finding servicesin quitting/finding services– ArrangeArrange for cessation services for cessation services
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Healthcare Provider Healthcare Provider OutreachOutreach Give healthcare providers the tools they Give healthcare providers the tools they
need on an ongoing basis need on an ongoing basis – Basic cessation intervention training (5As)Basic cessation intervention training (5As)– Collateral materials for waiting roomCollateral materials for waiting room– Strategies to change systems (chart Strategies to change systems (chart
– Outcome results per referralOutcome results per referral
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Healthcare Provider Healthcare Provider OutreachOutreach Distribute aggregate client data to MCOsDistribute aggregate client data to MCOs Mail tailored packets MCO clientsMail tailored packets MCO clients Mail thank-you letters, incentives, and Mail thank-you letters, incentives, and
publications to referring HCPspublications to referring HCPs
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Recruitment ResultsRecruitment Results
Are healthcare providers using the Are healthcare providers using the proactive referral system?proactive referral system?
Have changes in recruitment strategies Have changes in recruitment strategies influenced client characteristics?influenced client characteristics?
Arizona Department of Health Services - Tobacco Education and Prevention
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Referral ResultsReferral ResultsPassive Referrals to Helpline
38
143
181
119
98
16
59
75
4733
4 6 10 7 3
19
98
5567 69
0
50
100
150
200
Q1 02-03 Q2 02-03 Q3 02-03 Q4 02-03 Q1 03-04
Nu
mb
er o
f R
efer
rals
Passive Total LP WIC HCP WIC Referral Program is pilot (not statewide).
Total Passive Referrals to Date: 638Local Project: 243 (38%)WIC: 31 (5%)HCP: 371 (58%)
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Referral ResultsReferral ResultsProactive Referrals to Helpline
10
89
116 114
189
10
48
123
34
6 4 3 3
35
100108
152
0
50
100
150
200
Q1 02-03 Q2 02-03 Q3 02-03 Q4 02-03 Q1 03-04
Nu
mb
er o
f R
efer
rals
Proactive Total LP WIC HCP Total Proactive Referrals to Date: 779Local Project: 94 (12.1%)WIC: 21 (2.7%%)HCP: 565 (72.5%)
WIC Referral Program is pilot (not statewide).
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Referral ResultsReferral Results
Healthcare providers (HCPs) are more likely Healthcare providers (HCPs) are more likely to use proactive referral system than county to use proactive referral system than county health departmentshealth departments
Although Speakers’ Bureau training and Although Speakers’ Bureau training and other outreach activities have reached other outreach activities have reached hundreds of HCPs, only a core group uses hundreds of HCPs, only a core group uses the system. (113 HCPs of 2,555 in database)the system. (113 HCPs of 2,555 in database)
Acceptance of proactive referral system Acceptance of proactive referral system continues to growcontinues to grow
Arizona Department of Health Services - Tobacco Education and Prevention
Program
ServicesServicesHelpline Client Comparisons: Service Choice
79.8%76.4%
42.8%
36.5%
31.5%
20.2%23.6%
57.2%
63.5% 62.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FY 98-99 FY 99-00 FY 00-01 FY 01-02 FY 02-03
Pe
rce
nta
ge
of
Clie
nts
Information and Referral Counseling
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Call LanguageCall LanguageHelpline Client Comparisons: Call Language
6,650
5,538
3,978
3,463
2,219
181
1,144 1,186
275 170
6,8316,691
5,164
3,738
2,389
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
5,500
6,000
6,500
7,000
FY 98-99 FY 99-00 FY 00-01 FY 01-02 FY 02-03
Nu
mb
er
of
Clie
nts
English Spanish Total Clients
97.4%
2.6%
82.8%
17.1%
77%
23%
92.6%
92.9%
7.4% 7.1%
Arizona Department of Health Services - Tobacco Education and Prevention
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Health InsuranceHealth InsuranceHelpline Client Comparisons: Health Insurance Status
62.4%
58.1% 57.8%
69.3%
78.3%
24.3%27.5%
31.6%
21.4%17.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FY 98-99 FY 99-00 FY 00-01 FY 01-02 FY 02-03
Per
cen
tag
e o
f Clie
nts
Yes, Insurance No, Insurance
Arizona Department of Health Services - Tobacco Education and Prevention
Program
GenderGenderHelpline Client Comparisons: Gender
45.8% 45.8% 46.5%
40.3%38.0%
54.2% 54.2% 53.5%
59.6% 61.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FY 98-99 FY 99-00 FY 00-01 FY 01-02 FY 02-03
Pe
rce
nta
ge
of
Clie
nts
Male Female
Arizona Department of Health Services - Tobacco Education and Prevention
Program
Future AnalysesFuture Analyses
Further investigate changes in clientele Further investigate changes in clientele and recruitment (i.e., age, pregnancy and recruitment (i.e., age, pregnancy status, WIC status, education)status, WIC status, education)
Track and evaluate proactive referralsTrack and evaluate proactive referrals– What are the most productive referral sources?What are the most productive referral sources?
– How can the process be changes to increase How can the process be changes to increase recruitment of low SES clients?recruitment of low SES clients?
How with discounted NRT provision How with discounted NRT provision change recruitment in the future?change recruitment in the future?
Arizona Department of Health Services - Tobacco Education and Prevention