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Is Proud to Present our Monthly Webinar Series: Hot Topics in Tobacco Cessation & Secondhand Smoke Exposure Reduction Tuesday, February 5, 2008 12- 1 pm.

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Presentation on theme: "Is Proud to Present our Monthly Webinar Series: Hot Topics in Tobacco Cessation & Secondhand Smoke Exposure Reduction Tuesday, February 5, 2008 12- 1 pm."— Presentation transcript:

1 Is Proud to Present our Monthly Webinar Series: Hot Topics in Tobacco Cessation & Secondhand Smoke Exposure Reduction Tuesday, February 5, pm MT GoToMeeting: Call-in #: passcode: 74375# If you have any technical difficulties, please call Presented by Elizabeth Kraft, MD, MHS with support from:

2 2 Smoking Cessation/Secondhand Smoke Guideline : 1. ASK ADVISE REFER CCGC is your resource for tobacco information: 2. Integrate tobacco cessation into your practice: 3. Call CCGC to schedule a TRIA Call Emma at 303/ or 3 Things to Remember:

3 3 1.CCGC/Tobacco Program: Tobacco Cessation and Secondhand Smoke Exposure Guideline: ASK ADVISE and REFER CCGC tobacco resources 2.Practice redesign: TRIA 3.Hot Topics: Pharmacotherapy update PREP and SNUS Nicotine Vaccine Recruiting for a prenatal tobacco committee 4.Upcoming Webinars Objectives

4 4 1.Clinical Guidelines: Diabetes Depression Screening for Colorectal Cancer Asthma Pediatric and Adult Immunizations Upper Respiratory Infections Gestational Diabetes Obesity CV/Stroke Tobacco Cessation and Secondhand Smoke Exposure Colorado Clinical Guidelines Collaborative (CCGC) 2.Lead Agency for provider education and resource for tobacco cessation 3.Home for a national pilot called IPIP to I mprove P erformance I n primary care P ractices A coalition of health plans, physicians, hospitals, employers and other entities working together to implement systems and use evidence-based guidelines to improve healthcare in Colorado. 720/

5 5 Tobacco Use in CO 17.3% of Coloradans use Tobacco

6 6 The 5As Intervention Model Works


8 QUIT.NOW March 4 12 – 1 MT Webinar on QuitLine: What Colorado Physicians Need to Know About QuitLine 7 days/week Free coaching Free NRT patches x 1 month English, Spanish Special protocols for teens, pregnancy, smokeless

9 9 Have Tools Readily Available Order free supplies at:

10 10 A Resource for You Webinar recordings Calendar of events Training request forms Current research Funding opportunities Professional development

11 11 Question: How Can I Do a Better Job of Tobacco Cessation in My Practice? Insanity: Doing the same thing over and over again and expecting different results. -Albert Einstein

12 12 Tobacco Cessation Obesity Diabetes Apply these systems changes to other chronic conditions Answer: Practice redesign with tobacco cessation guideline integration as the process

13 13 Process: Use the tobacco cessation/SHS guideline: 2A/1R Lunch session with entire office staff: TRIA exercise Why tobacco cessation is important for your practice Brainstorm implementation goals for each team staff member Make changes after each patient Integrate Tobacco Cessation into YOUR Office: Tobacco Rapid Improvement Activity (TRIA) Tobacco Rapid Improvement Activity: Integrating Tobacco Cessation into Your Clinical Practice You Can Be the Difference!

14 14 View a video simulation of a Tobacco Rapid Improvement Activity (TRIA)

15 15 What really works, how do we prescribe, and what should we be looking for? What is the buzz about Chantix? It is recommended by the national PHS guideline to offer pharmacotherapy support, if there are no contraindications, as integral to tobacco cessation efforts. Hot Topic: Pharmacotherapy May – 1 MT Webinar: Pharmacotherapy for Tobacco Cessation: Treatment Update & Clinical Pearls

16 16 Pharmacotherapy Doubles cessation rates Can use >1 NRT Additive therapies Long term usage Tailor to your patient

17 17 % Quit Rates at 6 Months Am Fam Phys July 2006 page 263; JAMA July 2006

18 18 Recent Headlines Is Stopping Smoking a Suicide Risk? Chantix Suicidal Ideation Reports Doubled in 2 Months Girlfriend Believes Chantix contributed to Texas Musicians Death

19 19 Chantix: Update Chantix pharmacology: Selective nicotinic 4 β2 receptor partial agonist. Results in 30% less DA release than nicotine (lower craving) + antagonistic action that blocks reward properties (decrease satisfaction) Chantix labeling update: In January 2008, the CHANTIX product insert was updated to include a warning that patients who are attempting to quit smoking with CHANTIX should be observed for serious neuropsychiatric symptoms, including changes in behavior, agitation, depressed mood, suicidal ideation and suicidal behavior. What should I be doing with this new information? Observe all patients, including Chantix patients, for potential neuropsychiatric symptoms while trying to quit. Monitor frequently. Discuss risks of smoking, benefits of quitting, withdrawal symptoms, strategies to deal with withdrawal, support options (such as the QuitLine), & other pharmacotherapy options.

20 20 Hot Topic: SNUS/SLT/PREP- the Next Generation of Tobacco Products What is PREP, SLT and SNUS? PREP = potentially reduced exposure products (SNUS, snuff, lozenges) SNUS = snuff in Sweden; fine moist pasteurized smokeless spitless tobacco; teabag-like pouches; SLT = smokeless tobacco

21 21 Harm Reduction vs. Exposure Reduction Harm reduction – reduction in amount of tobacco related morbidity and mortality even with continued exposure to tobacco-related toxicants Exposure reduction- intervention designed to lessen intake of tobacco delivered toxicants National Guideline does not support harm reduction FDA does not regulate toxicant levels (as in Sweden) in SLT Data not clear and conflicting Nicotine still addictive SLT toxicants still harmful: Pancreatic cancer, metabolic effects (metabolic syndrome, fetal toxicity, unclear cardiac) & oral pathology

22 22 Hot Topic: Nicotine Vaccine Nicotine is not immunogenic Vaccine makes antibodies against nicotine Antibody is a large protein that binds to nicotine, making it unable to reach brain Linked to a viral base particle that will give mild viral syndrome (70%) Currently, 3 vaccines being tested: –NABI - 2 vaccinations with 2 boosters 25% stop smoking –TA-Nic- good efficacy (25% at 1 year); phase 3 –CYTOS – lots of side effects, phase 2, 9% improvement vs. placebo

23 23 Prenatal Tobacco Advisory Committee Prenatal tobacco use one of top reasons for low birth weight CCGC tobacco team is putting together an advisory committee If you have an interest or know of a provider who might be interested, please contact Emma at CCGC: 303/ or

24 24 National Tobacco Guideline First update since 2000 Will update 11 specific areas with evidence-based information CCGC asked to be a peer reviewer Anticipate release this Spring

25 25 CCGC Tobacco Webinars: Mark Your Calendar All webinars from 12-1 pm –Mar. 4, 2008: What Colorado Physicians Need to Know about the QuitLine, presented by Dr. David Tinkelman –Mar. 18, 2008: Clinical Practice Grant Opportunities –Apr. 1, 2008: Tobacco Cessation for Persons with Mental Illnesses: Primary Care Strategies, presented by Drs. Jeanette Waxmonsky & Alexis Giese –Apr. 15, 2008: Stages of Change & Motivational Interviewing with Clinical Populations, presented by Dr. Heather LaChance –May 20, 2008: Pharmacotherapy for Tobacco Cessation: Treatment Update and Clinical Pearls, presented by Laura Hansen, RPA –For more information on each webinar visit and click on Professional Development.

26 Visit : Questions? For a TRIA, contact: Emma at 303/ or 28

27 27 Thank you for your time

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