SVS members are taking advantage of the new Smoking Cessation Toolkit and resources from the Vascular Quality Initiative (VQI), adding them to existing programs and giving new life to their quest to get their patients to kick the nicotine habit and improve their health.
The SVS Patient Safety Organization (PSO) launched the national smoking cessation initiative, CAN-DO (Choosing Against Combustible Nicotine Despite Obstacles) in June during the VQI Annual Meeting held in conjunction with SVS’ Vascular Annual Meeting.
CAN-DO includes several components to increase smoking rates: physician and patient toolkits; including smoking cessation variables in the SVS PSO VQI’s arterial registries; and updating information on smoking cessation on the SVS website.
Toolkit elements that physicians and surgeons may find useful include:
- A quick guide to treatment options
- Information on counseling via text messaging
- Use of smartphone apps and web-based services
- Resource documents
- Information on quit lines
- Patient-facing information doctors can distribute
- Billable smoking cessation codes
The patient toolkit, meanwhile, includes links to many resources on quitting smoking.
“As vascular surgeons, we are tasked with helping our patients navigate through some of their most challenging and life-changing moments in their lives,” said Gary Lemmon, MD, associate medical director for the SVS PSO. “It is up to us to advise them as to their best chance of success and quality-of-life improvement. Smoking cessation assistance is integral to that success.”
Cassius Iyad Ochoa Chaar, MD, an associate professor of surgery at Yale University in New Haven, Connecticut; Yale postdoctoral research fellow Dana Alameddine, MD; and Peter Henke, MD, the section chair of vascular surgery at University of Michigan Health in Ann Arbor, Michigan, all are taking advantage of the toolkit to help strengthen their existing “quit smoking” messaging.
“This extensive toolkit is very, very helpful and user-friendly,” said Chaar. “We can incorporate the various phrases and strategies included and get all our providers to engage with them. If someone doesn’t want to prescribe medications, he or she can incorporate other elements VQI wants to encourage, such as counseling and nicotine replacement therapy.”
Their experiences with predecessor programs and, after reviewing the resources included in the new VQI initiative, led them to stress how an upcoming major inpatient surgery and its recovery provide a great opportunity to deliver the “quit smoking” message. Patients by and large will have to quit smoking while in the hospital, plus multidisciplinary teams are available who can reinforce the message from different angles. They also emphasized the importance of “systemizing” the effort by making sure it is part of the hospital system. “If you have to opt out, rather than opt in, that’s helpful,” said Henke. “Statewide, in Michigan, it became part of the discharge summary.”
The surgeons also noted how smoking cessation requires the emphasis the toolkit and initiative have created. The group also stressed that the tools in the toolkit are easily adoptable to different practices and physicians.
Surgery and recovery provide an optimal time to deliver the “quit smoking” message, said Chaar.
“We can basically reinforce the message on a daily basis—and we do that,” he continued. The patients also become “plugged into” the hospital smoking cessation program. Prior research shows that a lack of connection can impede patient follow-up, but inpatients receive both that link and that follow-up. “We’re able to sometimes provide them with medications, and we’ve given them nicotine patches in the hospital, so when they leave, we give them their best shot at stopping.”
Said Henke: “Surgery, particularly an aneurysm or bypass or similar major operation, is a major life event. They’ve had to quit smoking while they’re in the hospital—for weeks of hospitalization—so if they’ve stopped and then they’re smoking sporadically, perhaps you can transition them to a nicotine patch and varenicline. They have a higher quit rate as well, as compared to a patient who may have a one-day procedure.”
Chaar said the anti-smoking effort stretches across all medical teams that deal with smokers. “At every hospital we deliver the same message about smoking but from different angles,” he said. For example, cardiologists can point to cardiac disease, neurologists about strokes, and vascular surgeons about the many diseases smoking worsens. Oncologists can speak to the different cancers that can result.”
Yale physicians and providers are incorporating suggested thought phrases and incorporating the elements VQI wants to capture regarding counseling and treatment for patients into electronic health records, Chaar said. “So, we’re able to be early adopters and we can track this in our own institution and our health system, and also contribute to the nationwide initiative as well,” he said.
Yale has been very active in the smoking cessation movement, said Chaar. “It’s terrible for people with vascular disease and we’ve been trying to look at novel ways to help them quit.”
Michigan has been active too. “We were early adopters of this,” said Henke, who practices in that state. Michigan’s statewide quality collaborative created a cessation intervention initiative several years ago, in the wake of the VAPOR clinical trial results that covered the feasibility and pilot efficacy of a brief smoking cessation intervention delivered by vascular surgeons. The trial concluded that “implementation of a brief, surgeon-delivered smoking cessation intervention is feasible for patients with peripheral arterial disease. A larger trial will be necessary to determine whether this is effective for smoking cessation.”
The state added a fairly robust set of resources following the VAPOR trial. The new VQI toolkit, Henke said, adds impetus and heft to the state’s efforts. The initiative included nicotine replacement therapy, a referral to the telephone quit-line, and physician-delivered advice along the lines of “Smoking is harmful, it’s important to quit and how can we help you accomplish that?”
The quit-line has proved fairly successful, he said, noting that referrals to such help lines are part of the VQI toolkit.
Smoking cessation needs such emphasis engendered by the toolkit and initiative, Henke said, adding he hopes VQI and SVS leadership make this a top priority.
“Vascular surgeons almost more so than those in another field, see the ramifications and results of smoking,” he said. “We see amputations, death, aneurysm growth—all so smoking-related. We’re really at the front lines of this public health program.”
“The tools in the toolkit are easily adoptable,” he said. “And this is a super important message. It’s not as headline-striking as a new device, but it decreases amputation and death, heart attacks and strokes. It’s a no-brainer in one sense. But it’s hard to keep it in the forefront, when other topics grab headlines.”
The toolkit, pointed out Chaar, includes not only phrases and strategies physicians can use to help their patients stop smoking, but also information on the billing component of delivering such advice and resources. “That’s important for physicians’ and surgeons’ practices,” he said.
More information is available at www.vqi.org/quality-improvement/quality-improvement-tools.
