Dentist and Tobacco Cessation


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  • Why Promote Tobacco Cessation in the MCO? The MCO and the Columbia ATMC team have created interventions and educational modules for the dental office team and patient. The modules are offered to dentists for mandatory continuing medical education (CME) credit at no charge to the dentist.
  • The dental office setting is an appropriate arena for tobacco cessation interventions. More than 50% of smokers see their DDS at least once a year Oral health personnel have an established rapport with their patients Numerous 4-6 minute opportunities for prevention and cessation information Randomized controlled trials show that medical and dental teams using brief interventions can help patients stop tobacco use
  • Electronic detailing of dental offices has been received in a positive fashion. We have received inquiries and positive feedback from participating dentists. We have received no negative feedback from offices indicating that the electronic messages are not wanted. This was a concern, considering the amount of publicity surrounding the sending of unwanted e-mail messages (“Spam”).
  • “ I have received the DVD, have loaded it and watched it. I think it will be helpful for my practice. Thank you.” “ Please be advised that I have completed studying the Tobacco Cessation CD including taking the test. I must tell you that it has given me the ammunition and confidence to approach this important problem for the first time. Many thanks!” “ We have viewed the entire CD and find it informative, will positively try to integrate concepts with my practice.” “ Yes, I received the CD. Yes, I was able to load it into my computer. I might add that I was very impressed with the contents.”
  • Self-reported baseline tobacco related cessation behaviors were low. 51.9% (n=133) of dentists indicated that they recorded less than 20% of the time or never recorded information in the patient’s chart about their tobacco use.
  • 38.4% (n=133) reported asking patients about their tobacco use more than 40% of the time.
  • The discussion of setting of quit dates was not apart of dental practice for 71.6% of the dentists with tobacco using patients (n=134).
  • 76.3% (n=135) of dentists reported that they did not refer patients to tobacco cessation clinics/ programs as part of their tobacco cessation activities for patients who use tobacco products.
  • Only 17.9% (n=178) of dentists indicated that there knowledge about helping people stop using tobacco was very good or excellent. Dentists who reported there knowledge as good or excellent were more likely to discuss tobacco and general and oral health, the benefits of quitting, and to provide specific strategies for quitting for patients.
  • Dentist and Tobacco Cessation

    1. 1. Systems-Level Innovations to Promote Tobacco Treatment in Health Care Settings- Columbia University/ Aetna Dental "Tobacco and the Dental Office: Encouraging Patients to Quit" David A. Albert, DDS, MPH [email_address] 212-304-7172 Funded by the Robert Wood Johnson Foundation
    2. 2. Columbia University / Aetna Inc. Addressing Tobacco in Managed Care Dr. David A. Albert – Columbia University Dr. Donald Sadowsky – Columbia University Dr. Daniel Seidman – Columbia University Ms. Angela Ward – Columbia University Ms. Laura Akers – Deschutes Research Institute Dr. Judy Andrews – Deschutes Research Institute Mr. Steven Christiansen – InterVision Dr. Judith Gordon – Deschutes Research Institute Dr. Herb Severson – Deschutes Research Institute Dr. Thomas D. Gotowka – Aetna Dental Mr. Alan Hirschberg – Aetna Dental Ms. Dawn Romberg – Aetna Dental
    3. 3. The Dental Profession and Managed Care <ul><li>The Dental Managed Care Organization can serve as a facilitator for patient tobacco cessation advice and assimilation of tobacco cessation techniques into routine dental policies and procedures. </li></ul><ul><ul><li>Improved health outcomes can be understood as contributing to lower total health costs and to an augmentation of quality by the MCO. </li></ul></ul><ul><li>The Agency for Health Care Policy and Research Guideline #18(April 1996) recommends that insurers support tobacco user identification systems, support cessation treatment through staff education and training, and provide for reimbursement for tobacco-dependence treatment </li></ul>
    4. 4. Prevention in the Dental Office <ul><li>Why conduct tobacco cessation in the dental office? </li></ul><ul><ul><li>oral entry way </li></ul></ul><ul><ul><li>leukoplackic changes </li></ul></ul><ul><ul><li>bad breath </li></ul></ul><ul><ul><li>cosmetic defects </li></ul></ul><ul><ul><li>periodontal disease </li></ul></ul><ul><ul><li>oral cancer </li></ul></ul><ul><ul><li>not a candidate for prosthetics, implants </li></ul></ul>
    5. 5. Tobacco Cessation: Are dentists ready? <ul><li>Support from the American Dental Association </li></ul><ul><li>National Dental Association </li></ul><ul><li>American Academy of General Dentistry </li></ul><ul><li>NCI Dental Tobacco Steering Committee </li></ul><ul><li>AHCPR/ PHS Guidelines </li></ul><ul><li>Dental School Curriculum </li></ul>
    6. 6. Setting <ul><li>Aetna Dental </li></ul><ul><ul><ul><ul><li>One of the largest dental insurance companies in the US </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Market leader in the Dental HMO business </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Top 3 dental player by total membership (13 million covered dental members) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>DMO product serves approximately three million members </li></ul></ul></ul></ul><ul><ul><ul><ul><li>7,100 DMO GP locations </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Presence in 50 States </li></ul></ul></ul></ul>
    7. 7. Managed Care Commitment to Tobacco Cessation <ul><li>Commitment of Resources </li></ul><ul><ul><li>Network Managers, supervisory personnel </li></ul></ul><ul><ul><li>Regional Dental Directors, National Dental Director </li></ul></ul><ul><ul><li>Quality Assurance </li></ul></ul><ul><li>Dental Provider education and enhanced reimbursement </li></ul><ul><li>Patient education </li></ul>
    8. 8. Specific Aims ( &quot;Tobacco and the Dental Office: Encouraging Patients to Quit”) <ul><li>To stimulate tobacco cessation behaviors by subject-dentists </li></ul><ul><li>To incorporate systems-based strategies including tobacco user identification systems, education, financial incentives, and feedback </li></ul><ul><li>To determine whether a CD-ROM based educational intervention can increase the prevalence of cessation activities within the MCO dental practices </li></ul><ul><li>To evaluate the cost-effectiveness of the intervention </li></ul>
    9. 9. Intervention Components <ul><li>Continuing medical education via CD-ROM </li></ul><ul><li>Enhanced payment system for tobacco cessation in the dental office </li></ul><ul><li>Interactive electronic detailing sessions </li></ul>
    10. 10. System Change Development and Implementation <ul><li>The CD-ROM includes branding as an Aetna Dental product </li></ul><ul><ul><li>The cover art on the CD-ROM case and on the CD-ROM label were developed in close conjunction with Aetna Dental </li></ul></ul><ul><ul><li>The introductory segment of the CD-ROM contains video of the Head of Aetna Dental </li></ul></ul>
    11. 11. System Change Development and Implementation <ul><li>The incentive plan was developed and disseminated to participating dentists in the intervention arm </li></ul><ul><ul><li>The incentive plan builds upon lessons learned in the Columbia/ Aetna Dental ATMC 1 project </li></ul></ul><ul><ul><li>Aetna Dental provided the dentist with $10 for each Aetna DMO ® enrolled patient who received tobacco cessation counseling and completed the Columbia University Survey of Dental Patients during the enrollment period </li></ul></ul><ul><ul><ul><li>Dentists were informed of the compensation program when the patient surveys and materials were sent to them and via electronic detailing (e-mail) </li></ul></ul></ul>
    12. 12. System Change Development and Implementation <ul><li>Aetna Dental implemented an updated quality assurance system incorporating tobacco cessation questions into their periodic in-office reviews </li></ul><ul><ul><li>The modified system was implemented in the 29 States where dental offices are included in the study </li></ul></ul>
    13. 13. Study Design General practitioner offices in Aetna/DMO (n=6,822) Offices with more than 200 Aetna DMO adult patients (n=1508) Eligible offices (computer, CD-ROM, and Internet access) (n=501) Recruitment of Sample (224 met all eight inclusion criteria) 184 enrolled in program and randomly assigned to Usual Care (82) vs. CD-ROM-based training program (102)
    14. 14. Eligibility Criteria
    15. 15. Dissemination Vehicle
    16. 16. Minimum Requirements
    17. 17. DDS Baseline Data During the past month, approximately what % of the time did you ask about patient’s tobacco use? (N=133) 6.8% 39.1% 6.8% 15.8% 4.5% 27.1%
    18. 18. DDS Baseline Data During the past month, approximately what % of the time did you record information in patient’s chart about their tobacco use? (N=133) 1.5% 12% 23.3% 5.3% 29.3% 28.6%
    19. 19. DDS Baseline Data The extent to which discussion of setting specific quit dates and specific strategies for quitting are a part of your tobacco cessation activities for patients who use tobacco products. 28.4% 71.6% (N=134)
    20. 20. DDS Baseline Data The extent to which referral of patients to cessation clinics/programs is a part of your tobacco cessation activities for patients who use tobacco products. (N=135) 23.7% 76.3%
    21. 21. DDS Baseline Data Overall, how would you rate your knowledge about helping people stop using tobacco? (N=178) 19.1% 14% 27% 3.9% 36%
    22. 22. Patient Baseline Data - Tobacco Users How many times during the past 12 months have you seriously tried to quit? 51.2% 22.7% 11% 15%
    23. 23. Patient Baseline Data - Tobacco Users How confident are you that you will be able to stop using tobacco? 21.5% 47.6% 19.1% 11.8%
    24. 24. Patient Baseline Data - Tobacco Users Indicate where you are in your thinking about quitting tobacco products. 0 - not ready to quit, 10 - ready to quit now 16.8% 14.1% 9.1% 9.7% 10.4% 19.9%
    25. 25. Patient Baseline Data - Tobacco Users Over the past 12 months, how many visits did you make to the dental office? 18.1% 15.8% 31.7% 34.4%
    26. 26. Has anyone in your dentist’s office encouraged you to set a quit date? If yes, who? Patient Baseline Data - Tobacco Users 7.1% 18.4% 1% 21.4% 71.5% 28.5% 52%