Jump Starting Tobacco Health Systems Change Smoking is the leading cause of preventable illness and death in the United States.1 While the number of adults smoking in Minnesota has decreased to 14%,2 smoking rates remain high among specific populations, including populations of low socio-economic status.3 New research shows that brief tobacco use Jeyn L. Monkman, MA, BSN, NE-BC Megan N. Whittet, MPH Tani Hemmila, MS, BSW screening and interventions are among the top three preventative serresource-intensive for Community Health vices, providing substantial health benefits Did We Make A Difference? 4-5 Centers. We also discovered there were two and overall cost savings. “[The training] helped me be more mindmain interest areas: First, people wanted The question is, how can busy primaful of how I’m asking questions and havto know “how to ask the question” about ry care clinicians and staff more effectively ing discussions with patients.” tobacco and nicotine use more effectively. address tobacco use alongside everything Of the 107 participants, 50% completed Second, evidence-based prescribing of ceselse they do? evaluations following training and 90% sation medications and nicotine replaceMeeting Clinics Where They of respondents stated they were likely to ment therapies (NRT) was not widely Are: The Jump Start Model apply the motivational interviewing appracticed. ClearWay MinnesotaSM funded the Instiproach. When asked about the one thing We found that shorter, more focused tute for Clinical Systems Improvement they would do differently, most referenced trainings in the clinic setting were needed, project to increase clinic capacity to sysnot giving up on asking about tobacco and and developed the Jump Start for Tobacco tematically address patients’ tobacco use. nicotine use, and several specifically called Health Systems Change trainings. These While we worked with clinics and systems out changing prescribing practices. targeted training sessions were attended of all types and sizes, one of the target To get an understanding of how the by 107 clinic staff from seven Commuaudiences for programming was Comtrainings were applied, we followed up sevnity Health Centers. Sessions consisted of munity Health Centers. With the support eral months later. We interviewed six of the 30-60-minute trainings on motivational of the Minnesota Association of Comseven clinic leaders and sent out surveys interviewing to address tobacco and nicomunity Health Centers (MNACHC), we to clinic participants (18% response rate). tine use for any and all staff interested, and connected with the clinics and worked to While the number of survey responses was medication/NRT education for clinicians. understand their needs. low, we gained useful information from Dr. Pete Dehnel, Medical Director of the We found that typical, longer half-day prescribing clinicians: Twin Cities Medical Society’s Physician or full-day trainings were too time- and s &IVE OF THE SIX CLINICIANS STATED THEY Advocacy Network, provided education were more likely to discuss smoking about cessation medications. Resources cessation and offer medication/NRT included “How to ask about smoking By Jeyn L. Monkman, MA, BSN, NE-BC, with patients after having the training. without lighting a fire,” developed and Tani Hemmila, MS, BSW, and About half said they had patients who Megan N. Whittet, MPH shared by HealthPartners. 26
September/October 2018
MetroDoctors
The Journal of the Twin Cities Medical Society