With a clear sense of many of the opportunities on the horizon for quitlines, NAQC asked North Carolina’s seasoned tobacco control program manager, Sally Herndon, how do we most effectively leverage quitlines to improve cessation statewide/province-wide? As is the case in most states and provinces, tobacco control in North Carolina (NC) is a team effort. Sally pulled in Director of Tobacco Cessation, Joyce Swetlick, and NC’s Chronic Disease Director, Dr. Ruth Petersen. She also checked in with partners NC Prevention Partners, the NC Alliance for Health and the NC State Health Plan to come up with the following strategies for most effectively leveraging quitlines:

Work with quitline service providers to offer the most effective tobacco cessation services and provide strong documentation about the effectiveness and cost-effectiveness of quitlines. Cessation services through quitlines are customer friendly. Access and availability is much-improved over offering cessation classes, where there may or may not be a ready group at any given time. Quitline services, well managed, can be efficient and effective and a great source of real-time data in this information age!

Help people make the healthy choice, the easy choice. Evidence-based policies such as smoke-free environments and significant increases in tobacco prices through tobacco tax increases help prompt tobacco users to quit while quitlines help these tobacco users to stay quit.

Help clinics make the evidence-based choice, the easy choice. Quitlines are a great resource for busy clinicians. With a fully functioning quitline, busy clinicians can ask, advise, conduct brief counseling to determine readiness and discuss medications, and then refer to the quitline – either via fax or electronically through electronic health records. Expert quitlines then can do the heavy lifting – counseling - which is time consuming. They can get data back to each clinic. Clinics can even have "healthy competitions” to see which ones are doing best in offering this evidence-based service to tobacco users who want to quit. North Carolina’s Community Transformation Grant, led by Dr. Petersen, is a true team effort working to change health care systems to adopt clinical practice guidelines for tobacco cessation (as well as hypertension and cholesterol management). Working through NC’s AHEC Program and Community Care of North Carolina, we seek to create a medical home for all North Carolinians and advance evidence-based clinical practices by incorporating the 5 A’s into electronic health records and usual care.

Bridge these two concepts: promoting evidence based tobacco control policy with evidence-based services to help tobacco users who want to quit. Most tobacco users want to quit so let’s give them both the services they need and supportive community environments. Empower the experts in the white coats and stethoscopes to testify on behalf of their patients in support of evidence-based policies coupled with evidence-based tobacco cessation services.

Encourage clinicians to speak out! Clinics and hospitals that become dependent on quitline services to most efficiently meet clinical practice guidelines and federal regulations can be effective spokespersons for the value of these services to a community. Recently, decision-makers in tight budget times have tried to force a decision: Which is more important, policy change such as smoke-free environments or helping smokers/tobacco users quit? Answer: Both are critically important and go hand-in-glove.

Document and communicate the excess medical care costs of tobacco use and secondhand smoke exposure and the cost effectiveness and cost savings of quitlines to decision-makers, especially to publicly funded programs such as Medicaid and Medicare. In North Carolina, one of the biggest issues for these tight budget times is the cost of medical care. Excess medical care from tobacco use costs the state $2.4 billion each year and $769 million in Medicaid costs – not to mention $293 million in excess medical care costs due to secondhand smoke exposure. (NC Medical Journal Jan/Feb 2011) Quitlines are indeed cost effective and can help reduce these costs. For every dollar spent in FY11, QuitlineNC has provided a $2.55 return on investment.

Invite payers (insurers) and their customers (employers) to benefit from quitline efficiency and effectiveness by contracting to pay for quitline services for members/employees. North Carolina’s State Health Plan (SHP) contracts through the Tobacco Prevention and Control Branch with QuitlineNC, offering services to all state health plan members. Since providing these services through QuitlineNC, significantly more SHP members have enrolled in QuitlineNC services. In the second year, three times more members enrolled in QuitlineNC than before SHP became a fiscal partner. In addition, this cohort had the highest quit rate. The six month responder quit rate at 30-days point prevalence was 41.8% and the intent to treat rate was 21.1%.

Partner with those who serve highest risk. For example, QuitlineNC has become an important part of the effort to make all NC mental hospitals and substance abuse facilities 100% tobacco free. We learned that inpatients prefer tobacco cessation counseling from clinic staff, so we trained mental health and substance abuse staff in tobacco cessation and they make referrals to the quitline at discharge to help their patients who are very high risk stay tobacco free once they go back into the community.

Thanks North Carolina team!! How about your state or province? What strategies do you employ to leverage quitlines to improve cessation access and quality?