1. Creating Community-Clinical Linkages to Treatment
Cessation pathways:
Creating Community-Clinical Linkages to Treatment

2. Session Objectives Highlight the burden of tobacco use in Colorado
Review Colorado QuitLine program fundamentals, including access, eligibility and service delivery
Understand the critical role of providers on impacting quit attempts and cessation success

3. Smokers who are advised to quit attempt quitting at higher rates
Colorado Data Story
In 2016, nearly 68% of smokers attempted to quit
Among smokers who saw a health provider in the past year, advice to quit increased from 68.0% to 76.9% and referral to cessation treatment increased from 38.6% to 51.1%.
Adult smoking prevalence* in 2015 was unchanged from 2012, but not uniformly across population
groups. Compared with 2001, prevalence has declined significantly, although the number of
smokers has increased with the increasing population.As of 2015, there were approximately 600,000 adult Coloradans who currently smoke cigarettes.
Smokers who are advised to quit attempt quitting at higher rates

4. Colorado Data Story
Adult smoking prevalence* in 2015 was unchanged from 2012, but not uniformly across population
groups. Compared with 2001, prevalence has declined significantly, although the number of
smokers has increased with the increasing population.As of 2015, there were approximately 600,000 adult Coloradans who currently smoke cigarettes.

5. Statement on Structural Inequity
The Colorado Department of Public Health and Environment acknowledges that social, economic and environmental inequities result in adverse health outcomes and have a greater impact than individual choices. Reducing health disparities through systems change can help improve opportunities for all Coloradans.
What else do we know about current smokers?
Less likely to have a regular provider
● Less likely to have annual wellness visit and be up-to-date on preventive services

6. Disparities Snapshot Low SES Uninsured and Medicaid members
Adults <65 years
Native American & Black
LGBT
Unemployed & unable to work
Persons with behavioral health conditions
Pregnant women
Access VISION:
Smoking prevalence rates across demographic groups (Table 1) include several groups with continued
significant declines since 2001, but little significant change occurred after Little or no progress
occurred toward closing prevalence gaps between low- vs. non-low-SES populations and young adult
students vs. non-students. In the past 15 years, prevalence remained basically unchanged among men,
adults aged 25+, and the state’s largest nonwhite populations. SES patterns of smoking were recognized
during a period when Colorado's population was growing through migration but losing socioeconomic
ground, with 32.2% classified as low SES in 2001 compared with 51.0% in The SES population
trend converged with a lack of meaningful cessation progress among low SES smokers. As a result, while
roughly half (52.5%) of Colorado smokers had low SES in 2001, three-fourths (75.1%) did in 2015.
Smoking in Colorado is now fundamentally a low-SES problem.

7. Disparities: LSES
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

8. Disparities: Insurance
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

9. Disparities: Mental Health
Data Source: Behavioral Risk Factor Surveillance Survey (BRFSS)

10. Disparities: Cessation Success
Data Source: The Attitudes & Behaviors Survey (TABS)

11. Portrait of a Current Smoker
Less likely to have a regular provider
Less likely to have annual wellness visit and be up-to- date on preventive services
Less likely to meet nutrition and physical activity recommendations
More likely to be diagnosed with COPD, arthritis, cancer, cardiovascular disease, and depression
Likely to have attempted to quit smoking in the past year
What else do we know about current smokers?

12. The Impact of Provider Advice
Compared to people who smoke who do not get help from a clinician, those who get help are 1.7–2.2 times as likely to successfully quit for 5 or more months1.
1Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update.

13. Tobacco Use Standard of Care
All patients should be asked if they use tobacco and should have their tobacco use status documented on a regular basis
 All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates
Every tobacco user should be offered at least a minimal intervention and referral to evidence-based treatment, such as the Colorado QuitLine

14. Service Delivery Basics
This section will highlight current QuitLine benefits and accessibility options for Colorado residents.
QuitLine
Service Delivery Basics

15. Why QuitLine? Quality Access Coordination
QL can provide the treatment intensity that often cannot be offered in a clinical setting due to time constraints
QL works in conjunction with physician intervention and provides feedback on client progress
QL increases access & reduces barriers, including those related to: cost, travel, language & business hours

16. QuitLine: At a Glance How To Reach Us Features
1-800-QUIT-NOW
(CO direct)
1-855-DEJELO-YA
(TTS)
Features
Intensive, client-centered coaching
Confidential
Non-judgmental
Free NRT
Self-help materials
Text-messaging and support

17. Eligibility To enroll, caller must be: a Colorado Resident
15 years of age for the coaching program
18 years of age to receive cessation medication*
Insurance status and nicotine dependence levels are not eligibility criteria
*Provider consent is required for individuals self-reporting uncontrolled hypertension, heart attack or stroke occurrence within the past calendar year; and for pregnant and breastfeeding women

18. Access & Enrollment Participants can enroll by
Phone (1-800-QUIT-NOW)
Provider Referral (fax, web or e-referral)
Online (COQuitLine.org)
7 day per week, Multilingual Call Center
5 am to 11 pm MST
Voic available 24 hours
5 Call Program
Up to 5 Coaching Calls (Outbound at scheduled times)
Unlimited inbound calls for support

19. Referral Program QuitLine receives referral
Patient receives call from QL within 48 hours
Up to 3 attempts are made to reach client over a 10 day period
Fax back to HIPAA covered provider:
When referral is received
When patient enrolls, is unreachable or declines
When patient receives NRT
When patient completes the program

20. Pharmacotherapy Benefit
Every CO participant (18 or older) enrolled in coaching is eligible for 2 quit attempts and 2 courses of nicotine replacement therapy (NRT) or 1 course of Chantix per 12 months*
Products shipped direct to client’s residence
Clients must maintain enrollment in the coaching program to receive additional medication shipments
*A client's calendar year begins on the date of their first QuitLine medication order.

21. NRT Options Monotherapy Patch, gum, or lozenge offered (one product)
Course of therapy delivered in two, four week shipments
Combination Therapy
6 weeks of patch plus short acting NRT (gum or lozenge) and one additional 2 week course of monotherapy (client choice of product).

22. Chantix® (varenicline) Benefit
Standard course of Therapy
Clients are eligible to receive one* 12 week course annually
Provider prescription is required and faxed direct to Ridgeway mail order pharmacy
*For clients who cannot tolerate Chantix, or who choose to discontinue the product after one month, a full 8 week course of NRT may be offered as a replacement to support the first quit attempt. 

23. Chantix® (varenicline) Process Flow

24. Ridgeway Pharmacy Accepts prescriptions via fax, e-script and mail
Licensed to sell prescriptions in all 50 states
2824 US Hwy 93 North
Victor, MT 59875
Phone:
Fax:

25. Digital Promotion

26. Colorado Medicaid
All FDA-approved cessation medications are covered* at low or no cost for up to two 90 day courses of treatment
*Prior Authorization and cessation counseling required
Individual and group behavioral counseling are offered by qualified providers at no cost

27. Thanks for all you do to support tobacco cessation in Colorado.
Contact
Michelle Lynch
Cessation and Health Systems Supervisor, CDPHE
Thanks for all you do to support tobacco cessation in Colorado.