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By Rita Svatos, RN, BSN, Director,
Affinity NurseDirect Call Center
Menasha, Wis.
High Levels of Tobacco Use in Service Area
Alarmed by high levels of tobacco use in our northeastern Wisconsin service area, Affinity Health System wanted to find an effective method to help smokers quit. Well-documented studies have long demonstrated that tobacco use increases the incidence of a host of diseases and results in increased healthcare claims. The answer was prevention in the form of a smoking cessation assistance program that achieved greater than national average quit rates while rating high in patient satisfaction.
A Growing Health Threat
Touching more than 46 million Americans, smoking and the use of tobacco products is the most preventable cause of premature death in the U.S. More than a decade ago when we started to focus on cessation efforts, tobacco use in Wisconsin was 24% among adults. Even worse, 37% of Wisconsin teens 14-17 years of age were using tobacco.
To create an effective program, we needed to integrate all patient information into one system to identify and manage patients seeking long-term cessation solutions.
While attending a conference, I learned about another organization's success in helping patients quit smoking with McKesson's RelayHealth CareEnhance® Call Center solution. We already were using the system to manage our 24-hour Affinity NurseDirect triage call center, which I direct, as well as physician and training class referrals. I realized we already had a versatile software tool that could be tailored for use in this new project.
Technology to Support Cessation
We expanded our use of the software by creating the Call it Quits Tobacco Cessation Program. Its primary focus was to help patients, employees and community members become tobacco-free. Our goals were straightforward:
 Increase the number of physicians advising their patients to
quit tobacco
Offer patients at Affinity hospitals bedside intervention, physician
interaction, pharmaceuticals, counseling and telephone follow-up
Benchmark participants who are tobacco-free after one year
against national averages
Educate teens about the harmful effects of tobacco
The Affinity team, working in conjunction with RelayHealth professionals, programmed the solution to meet the needs of providers and patients. The program was designed to leverage tobacco users' "teachable moments" such as physician interventions, counseling and telephone follow-ups. It was also designed to provide cessation information through the call center's disease management, survey, education and class registration modules. We added a customer relationship module to the call center that enabled us to flag patients for routine outbound calls at key cessation intervals.
On-Call Around the Clock — Affinity NurseDirect staff members are on-call around the clock to offer support to call-ins. During times of high call volume, carefully scripted encouraging messages play while callers are on hold. In addition, community bulletins, brochures, training classes and lunch-and-learn programs spread the word among Affinity practitioners, work locations and the community at large.
Registry of Tobacco Users — The Affinity NurseDirect team also partnered with our Cardiac Rehabilitation Department and the Nursing Documentation Team to create a registry of all tobacco users admitted to our hospitals. In 2008, 410 of the 1,584 patients referred to the Call It Quits program were enrolled. In addition, a work-site tobacco cessation program, which offers pharmaceuticals paid for by employers, has realized quit rates from 30% to 59%.
Cessation Course for Teen Tobacco Offenders — Affinity partnered with local law enforcement officials to implement a tobacco cessation education course for teens charged with tobacco possession. Upon completion of the classroom program, 98% of graduates reported that they plan to reduce or quit tobacco usage altogether.
Healthy Results
By 2008, Affinity's Call it Quits program achieved some outstanding results:
Surpassed national averages for tobacco quit rates – 72%
compared to 42% nationally
Reduced adult tobacco usage from 24% to 19%
Reduced teen usage from 37% to 21%
Improved physician referrals from 67% to 80%
Achieved a 92% user satisfaction rate
By leveraging sophisticated technology to help tobacco users quit, Affinity Health System is making significant and long-lasting improvements. These results are reflected not just in the initial success of fewer people smoking or using tobacco products, but more importantly, in a healthier community.
Affinity NurseDirect Call Center is a winner of McKesson's 2009 VIP Award. Each year McKesson recognizes customers that demonstrate vision and innovation in the use of information technology to enhance healthcare performance.
Rita Svatos RN, BSN, PN, is the director of four departments for Affinity Health System: NurseDirect, LifeSpan Community Health Education, Life Line and the Customer Care Center (the telecommunications hub for Affinity Health System that currently averages 2,200 calls per day). She began her nursing career working in a hospital cardiac unit, later moving to newborn care, home health, hospice and community health. Svatos is an active member of the American Academy of Ambulatory Care Nursing (AAACN) and is a past chair for the Special Interest Group Telephone Nursing Practice committee. She has been a featured speaker at the InSight Annual Conference for users of McKesson technology solutions and the AAACN annual nursing conferences.
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