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ššø\Ve2121  2121 21         ƒ š0ƒ†AæĄÅA’@ń÷š8ó€ó€ŠUŗ“°öŹš;­”ĒŹš;śgžż4QdQd ¶’—É 0ž’’¬’’’pūppū@ <ż4dddd@—‘w 0t©Üz’’ <ż4BdBd@—³x 0t©<ż4!d!d@—³x 0t©ˆŅŠ0ŗ___PPT10‹ ĄĄŠ’ŗ___PPT9‹t®lÆ!¬€’’Æ ¬ €’’?Ł Ś %šł2óŸØ/Quitlines: Considerations for Future Directions”.0 H=%6Ÿ :Christopher M. Anderson California Smokers Helpline University of California, San Diego European Network of Quitlines Conference 10-11 December 2007 - Rome”žZžó!Ÿ @The California Smokers Helpline”!!ŸØéBackground Funded by tobacco taxes In continuous operation by UCSD since 1992 Over 440,000 callers served Annual budget US$4.5 million 45 counselors 6 languages 07:00-21:00 Mon-Fri, 09:00-13:00 Sat Dual mission: service and research”, ß  ßó"Ÿ @The California Smokers Helpline”!!ŸØĶLarge, randomized controlled trials English & Spanish speaking adults Pregnant smokers Adolescents NRT users Asian language speakers Current studies Proxy callers Direct marketing Quitline data repository”`%ZaZZ8Z% a 8ó# ŸØQuitlines in the U.S.”ŸØ2A national network Federal government provides 1-800-QUIT-NOW to link US quitlines All 50 states fund quitlines Some national promotion 20+ quitlines operators Friendly but real competition North American Quitline Consortium facilitates information sharing among US and Canadian quitlines (and now Mexico) ”FZZZ  ó%"ŸØQuitlines in the U.S.”ŸØ2Current status Calls answered live 96 hrs/wk (median) Counseling available 87 hrs/wk (median) 100% provide proactive, multiple sessions (median goal is 5 sessions) 35% provide pharmacotherapy Median annual budget is US$622,000 (Budget & reach are strongly correlated) Average quitline reaches 1% per year ”@" " ó$!ŸØ$Considerations for future directions”%%ŸØßBenchmarking/quality improvement Expanding the menu of service offerings Adapting protocols to a wide range of quitline users Funding for growth Integrating with health care Promoting quit attempts in the larger population ”2ß’nß ó ŸØ$1. Benchmarking/ quality improvement”%%Ÿ |In a recent survey, NAQC members were asked:  Describe one significant quality improvement that you would like to see, either in your own quitline or in quitlines generally. The improvement could be in any area (e.g., service delivery, promotion, funding, contracting, integration with health care, evaluation, etc.) ”0-ZZ- ó ŸØ$1. Benchmarking/ quality improvement”%%Ÿ Ę113 members responded with desired improvements in the following areas: Service delivery  47 Evaluation  29 Integration with health care  29 Promotion  24 Funding  17 Contracting & other  7 (Many respondents mentioned >1)”8H| H œóŸØ$1. Benchmarking/ quality improvement”%%Ÿ ōNumber of respondents who were content with things as they are: 0 Main (subjective) findings: NAQC members& Are excited by their evolving field Want much more from quitlines Are working to make it happen Want to compare notes with colleagues”,u†u †ó  ŸØ A proposed framework for quality”!!ŸØśThe Quality Assurance Project Funded by the US Agency for International Development Focuses on: clients, systems and processes, measurement, and teamwork Mission is to strengthen quality of health care in developing world Ideas are broadly applicable”,Ż Żó ŸØQAP: 9 dimensions of quality”(ŸØ³Technical performance Access to services Effectiveness of care Efficiency of service delivery Interpersonal relations Continuity of services Safety Physical infrastructure Choice ”0³’n³ó ŸØa. Technical performance”ŸØ‘Does the quitline recruit capable counselors? Does it provide them with optimal training and continuing education? Do counselors follow protocol?”’’ó ŸØb. Access to services”Ÿ bDo hours of operation meet the need? Are calls answered live and promptly? Are services provided in callers preferred languages? Are there enough counselors to meet the demand? Is the literacy level of program materials appropriate to the clientele? Are barriers to pharmacotherapy as low as possible? ”<00ó ŸØc. Effectiveness of care”ŸØAre protocols based on the best available evidence? Are referrals converted to clients? Do callers opt for counseling? Do those opting for counseling receive it? Do they set a quit date? Do they make a serious quit attempt? Do they maintain long term continuous abstinence? ”<óŸØ!d. Efficiency of service delivery”""Ÿ ĢDo callers receive immediate service? Is phone tag minimized? Is counselors time spent actively helping clients? Is administrative work streamlined so they can focus on clinical work? Are the services provided cost-competitive? ”<ååóŸØe. Interpersonal relations”ŸØAre callers greeted courteously and professionally? Do counselors exhibit empathy? Do they establish and maintain rapport? Do they practice Motivational Interviewing? Is the rationale for questions and treatment decisions made clear? Is confidential information protected?”óŸØf. Continuity of services”ŸØ-Does the quitline move referred patients seamlessly into treatment? Do referred patients experience the quitline as an extension of their health care? Is therapeutic rapport maintained and increased over successive sessions? Does the quitline remember repeat callers? Does it actively re-engage them?”..óŸØ g. Safety” ŸØ·Are crisis situations managed so as to minimize the risk of harm to self or others? (suicide, homicide, child or elder abuse, etc.) Are contraindications for pharmacotherapy observed?”øøóŸØh. Physical infrastructure”ŸØĮDoes the quitline have robust telecom and data systems for managing telecommunications and data collection, management, and retrieval? Are personnel functions optimally supported by technology?”ĀĀóŸØ i. Choice” ŸØ1Are clients offered a range of services including but not limited to counseling? Are clients informed of evidence-based programs in their local area? Are callers offered counseling either immediately or at a time of their choosing? Do counselors facilitate movement rather than dictating a plan of action?”22ó'$ŸØ*2. Expanding the menu of service offerings”++ŸØēBarriers to pharmacotherapy could be reduced Innovations in telephony may be worth exploring (texting, predictive dialer, IVR, video) Web-assisted interventions, if shown to be efficacious, may increase reach very cost-effectively ”,ēē Ŗ^ƒó(%ŸØ73. Adapting protocols to a wide range of quitline users”88ŸØ#For certain populations, specialized protocols are warranted (chewers, teens, pregnant, mental health) Is the same true for all demographically identifiable groups? Perhaps not. How to handle the many non-registered callers? Provide abbreviated services for callers with fewer risk factors? ”,## ó)&ŸØ'4. Increasing the funding for quitlines”((ŸØAverage quitline in the U.S. currently reaches 1% of smokers per year CDC sets bar at 8% DHHS National Action Plan calls for 16% Much bigger public investment is needed to achieve a large impact on public health Promising approach: cost sharing between public and private sectors”ó*'ŸØ)5. Integrating quitlines with health care”**ŸØAvailability of a quitline can encourage health care providers to address tobacco use in all patients Proactive enrollment of patients may persuade more providers to refer Promoting quitlines through health care systems can amplify the effects of a quitline working alone”ó+(ŸØ16. Promoting both aided and unaided quit attempts”22ŸØŅAdvertising a quitline can spark quitting among callers and non-callers alike Quitline promotion can also spur nonsmokers to take action How best to leverage quitline to maximize impact on entire population? ”ÓÓó&#ŸØ References” ŸØvAnderson CM, Zhu SH. Tobacco quitlines: looking back and looking ahead. Tob Control 2007; 16(Suppl):i81-86. Cummins SE, Bailey L, Campbell S, Koon-Kirby C, Zhu SH. Tobacco cessation quitlines in North America: a descriptive study. Tob Control 2007; 16(Suppl):i9-15. U.S. Agency for International Development. Quality assurance project. Online at http://www.qaproject.org/. ”6wH ” …Ŗ`HCUpņóŸ 0ßZsó ŸØ Thank you!ŸØFFor questions or comments, contact: Chris Anderson cmanderson@ucsd.eduŖ3źųė ļ  0`š ’’’f™™’™Ģ™™™f’˜œŗ`š \'’’’€€’Ż‰ĢfĢ™f™£¢t`š 3’’’v;Ģ™’ĢĢ3ff™™™f`š Q%]’’’m6–’’Ģff™€€ĢĢ£¢t`š JU;’’’Ģf’æ’ĢĢ™f™£¢t`š ’’’’Ģff™’™’ff™™™f`š ’’’f3Ģ3’ĢĢfĢ™™f3`š ’’’ff™™™ĢĢĢf’ĢĢ™£>’ż?" dd@’’ļ’’’’’’,£”’ż?pKdŲ@’’ļ’’’’’’ nŌ ąpAŠ@č§dš`hP€ £n’ż?" d’d@’’ļ’’’’’’   @@``€€P£T    @ ` €`£:p£>€£> XšPš œščš( š šœšą šœ “ š6€䒇ƒæĄ’ "ńæšÆ `}šĆ ’ šTŸØ Click to edit Master title style¢!Ŗ !š$ šœ ƒ š0€šę’ƒæĄ’ "ńæšš `šĆ ’ šžŸØRClick to edit Master text styles Second level Third level Fourth level Fifth level¢!    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