Getting Out the Word on Effective Tobacco Treatment
Clinical guidelines are only as good as the number of people who read and use them. In 2005, fewer than 50 percent of smokers visiting a health care setting were treated for tobacco use, according to the Center for Tobacco Research and Intervention at the University of Wisconsin. That gap occurred despite Treating Tobacco Use and Dependence, a clinical guideline from the U.S. Public Health Service published in 1996 and updated in 2000.
The center was the lead organization producing a 2008 update of the guideline, which recommends treatment options based on evidence about what works. For example, the update advises clinicians to prescribe both counseling and smoking-cessation medication to patients who want to quit unless otherwise contraindicated (as medication is with pregnant women). Eight organizations, including the Robert Wood Johnson Foundation (RWJF), funded the update (see Grant Results).
To spur widespread use of the revised guideline, RWJF provided another grant to the center to update educational information and tools, create new tools and disseminate them to clinicians and consumers. This work, which ran from 2008 to 2009, built on a decade of efforts by RWJF to boost smoking treatment and quit rates . See the Special Report.
By 2008, many "people were eager to see the next guideline and use it," according to Bruce Christiansen, Ph.D., project co-director. However, they still needed information encouraging and helping them do so. The center used this grant to provide that support.
In reports to RWJF, project staff noted the following results as of December 31, 2009:
- The Center for Tobacco Research and Intervention produced information and tools on the revised guideline in print, electronic and video formats for both clinicians and consumers. For example, project staff:
- Published articles with co-authors in four peer-reviewed journals, including JAMA.
- Produced nine videos for clinicians on the "right" and "wrong" way to talk to patients who don't want to quit smoking. (Available online; each viewed 850–900 times.)
- Published a "How-To Guide for Treating Patients Who Use Tobacco," which walks clinicians through the process of helping patients quit smoking, and gives advice on helping patients who don't want to quit. (Available online; viewed 4,295 times.)
- Created a Web site to facilitate clinician and researcher access to the updated clinical practice guideline and related materials.
- Created "Tobacco Use and Dependence: An Updated Review of Treatments," a webinar for continuing medical education. Some 9,055 health professionals received credit for completing the free webinar, available online at Medscape, an information service for clinicians.
- Produced eight case studies on successful smoking-cessation initiatives in Wisconsin, including a rural clinic in Cashton, a university clinic in Appleton and an Indian Health Service clinic in Milwaukee. (Available online; viewed 1,852 times.)
- Produced a booklet on smoking cessation for smokers with low literacy levels, and handouts on creating a personalized plan to quit smoking.
- To ensure widespread awareness of the guideline and distribution of information on it, project staff worked with many of the 59 medical and public health organizations that endorsed the guideline, as well as other organizations and the media. For example:
- The federal Agency for Healthcare Research and Quality (AHRQ) distributed 418,283 copies of printed materials, including the 2008 guideline, clinician's pocket guide and consumer's guides in English and Spanish.
- The Office of the Surgeon General and AHRQ posted the information and tools on their Web sites.
- Project staff worked with professional organizations to publicize the guideline through listservs, teleconferences and webcasts. The groups included the Spanish Society of Pneumology and Thoracic Surgery, Barcelona, which translated the guideline into Spanish. See the Appendix for the organizations.
- Project staff placed articles on the guideline in the AARP Bulletin, American Legion Magazine, Physicians Weekly, American Nurse Today and Medical News Today. Time magazine interviewed project co-director Michael Fiore, M.D., M.P.H., in August 2009 and posted an online article about quitting smoking that referenced the guideline.
- Project staff gave slide presentations and held workshops at state and national meetings, such as at the June 2009 National Conference on Tobacco or Health in Phoenix.
- Tap electronic media, such as webinars, webcasts and listservs, along with print media such as journals and magazines to disseminate information. The Center for Tobacco Research and Intervention created materials in a variety of formats and posted them on numerous Web sites. Such efforts can extend your reach at relatively low cost. (Fiore and Christiansen/Project Co-Directors)
- To promote a continuing education curriculum, contact professional associations that do not provide their own CE program to their members. Those that do are reluctant to post/host the CE developed under an external project. The Society for Research on Nicotine and Tobacco and the Association for the Treatment of Tobacco Use and Dependence agreed to promote the center's free course. (Christiansen/Project Co-Director)
- Work with partners at professional organizations to widely disseminate new health care standards. Members of the panel overseeing revision of Treating Tobacco Use and Dependence gave the center's outreach effort "instant credibility" with their organizations, and opened doors to enlist them in that effort. (Fiore and Christiansen/Project Co-Directors)
The Robert Wood Johnson Foundation (RWJF) supported this project with a grant of $97,578 from January 2008 to December 2009.
The Center for Tobacco Research and Intervention continues to provide ad hoc assistance to a variety of organizations both nationally and internationally. For example, in June 2010, the center assisted the American Heart Association in its development of Coronary Heart Disease Secondary Prevention Guidelines regarding recommendations for the treatment of tobacco dependence.
In addition, the center has moved from disseminating information on the guideline to helping to implement it, according to Christiansen. Recent grants to the center for such efforts include:
- A $1 million, two-year grant from the National Cancer Institute to assess the effectiveness of various combinations of strategies to help smokers quit though a quitline, as recommended by the guideline. The project began in September 2009.
- A $9.3 million, five-year grant from the National Cancer Institute for three studies of strategies noted in the guideline to help smokers quit. The project, which focuses on primary care clinics throughout Wisconsin, began in September 2009.
GRANT DETAILS & CONTACT INFORMATION
Updating, testing and disseminating the 2008 tobacco treatment guideline
University of Wisconsin School of Medicine and Public Health (Madison, WI)
Dates: January 2008 to December 2009
Professional Organizations Publicizing the Clinical Guideline on Treating Tobacco Use
Professional organizations helping to disseminate information on the 2008 update of Treating Tobacco Use and Dependence included:
- American Academy of Family Physicians, Leawood, Kan.
- American Academy of Nurse Practitioners, Austin, Texas
- American Academy of Pediatrics, Elk Grove Village, Ill.
- American Association for Respiratory Care, Irving, Texas
- American College of Obstetricians and Gynecologists, Washington
- American College of Physicians, Philadelphia
- American Medical Association, Chicago
- American Nurses Association, Silver Spring, Md.
- American Osteopathic Association, Chicago
- American Thoracic Society, New York
- National Medical Association, Silver Spring, Md.
- Society of General Internal Medicine, Washington
- Spanish Society of Pneumology and Thoracic Surgery, Barcelona
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
2008 PHS Guideline Update Panel, Liaisons, and Staff. "Treating Tobacco Use and Dependence: 2008 Update—U.S. Public Health Service Clinical Practice Guideline—Executive Summary" Respiratory Care, 53(9): 1217–1222, September 2008. Available online.
The Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel Liaisons, and Staff. "A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update: A U.S. Public Health Service Report." American Journal of Preventive Medicine, 35(2): 158–176, 2008. Abstract available online.
Fiore MC and Jaén CR. "A Clinical Blueprint to Accelerate the Elimination of Tobacco Use." Journal of the American Medical Association, 299(17): 2083–2085, 2008. Extract available online.
Fiore MC. "Treating tobacco use and dependence: Clinical practice guidelines update". Society for Research on Nicotine and Tobacco Newsletter, June 2008.
Koop CE, with contributions from Fiore MC and Hollenback C. "It's Never Too Late to Quit Smoking." AARP Bulletin, September 2008.
Helping Smokers Quit: A Guide for Clinicians. Rockville, MD: Agency for Healthcare Research and Quality, revised May 2008. Available online.
You Can Quit Smoking. Support and Advice from Your Clinician. Consumer Tear Sheet. Rockville, MD: U.S. Public Health Service, Agency for Healthcare Research and Quality, September 2008. Available online.
You Can Quit Smoking. Support and Advice from Your Prenatal Care Provider. Consumer Tear Sheet. Rockville, MD: U.S. Public Health Service, Agency for Healthcare Research and Quality, September 2008. Available online.
Usted puede dejar de fumar: Apoyo y consejos de su profesional de salud. Clinician Tear Sheet, Spanish. Rockville, MD: U.S. Public Health Service, Agency for Healthcare Research and Quality, revised October 2008. Available online.
Usted puede dejar de fumar: Recomendaciones como apoyo de su médico de cuidados prenatales. Clinician Prenatal Tear Sheet (Spanish). Rockville, MD: U.S. Public Health Service, Agency for Healthcare Research and Quality, revised October 2008. Available online.
Help for Smokers and Other Tobacco Users. Consumer Guide. Rockville, MD: U.S. Public Health Service. Agency for Healthcare Research and Quality, May 2008. Available online.
Making tobacco dependence treatment a standard of care: a systems approach. Madison, WI: University of Wisconsin Center for Tobacco Research and Intervention, May 2008. Available online.
Treating Tobacco Use and Dependence slide presentation (overview). Rockville, MD: U.S. Public Health Service, Agency for Healthcare Research and Quality, June 2009. Available online.
Treating Tobacco Use and Dependence slide presentation (full set). Rockville, MD: U.S. Public Health Service, Agency for Healthcare Research and Quality, June 2009. Available online.
World Wide Web Sites
www.ctri.wisc.edu/Researchers/researchers_CPGupdate2008.htm. Web site created to facilitate clinician and researcher access to the updated Clinical Practice Guideline and materials available through AHRQ. Madison, WI: University of Wisconsin Center for Tobacco Research and Intervention.
http://cme.medscape.com/viewprogram/583425. Content of this online CME program housed on Medscape was created by UW-CTRI based on the updated Clinical Practice Guideline. New York: Medscape LLC.
"The U.S. Public Health Service Clinical Practice Guideline 2008: Treating Tobacco Use and Dependence Update." Presented on May 21, 2008, Madison, WI; May 28, 2008, Rothschild, WI; June 3, 2008, Menasha, WI; June 10, 2008, Mondovi, WI; June 18, 2008, West Allis, WI; October 10, 2008, Hayward, WI.
"2008 PHS Clinical Practice Guideline Update: Treating Tobacco Use and Dependence." Presented on October 15, 2008, via a CDC teleconference with 8 states.
"So Your Patient Doesn't Want to Quit: Assisting the Unmotivated Tobacco User." Webcast presented on November 7, 2008. Also available online.
"The 2008 Public Health Service Practice Guidelines on Smoking Cessation: Opportunities and Challenges to Further Progress." Presented on June 10, 2009, National Conference on Tobacco or Health, Phoenix, AZ.
Report prepared by: Linda Wilson
Reviewed by: Sandra Hackman
Reviewed by: Molly McKaughan
Program Officer: C. Tracy Orleans