In the 10 years since September 11, 2001, tobacco use has been recognized as the number one cause of COPD. In America, tobacco use by men has dropped slightly, while its use by adolescent girls has risen slightly.
In New York City, 15% of first-responder rescue workers from the Fire Department of the City of New York (FDNY) considered themselves to be current smokers at the time the World Trade Centers fell. In the aftermath of this event, 98% of these workers reported acute respiratory symptoms, and 81% expressed health concerns. David J. Prezant, MD, FCCP, along with several others, worked very closely with these first responders and enrolled the FDNY cigarette smokers in “Tobacco Free with FDNY,” a free quit-smoking program that provided counseling, support, and medications. It began with the FDNY use of the ACCP Tobacco Dependence Treatment ToolKit (TDTTK) and continues today.
The CHEST Foundation at the ACCP has created a number of prevention materials, which have been translated into several different languages, to convince people of all ages not to smoke. These materials include PowerPoint slides, coloring books, lectures, and allergy sheets, among other materials.
A committee that included Dr. Prezant and was chaired by David Sachs, MD, FCCP, created the tool kit. Funds provided by Pfizer supported the initial development of the Web-based TDTTK, although the company was not involved in its contents or distribution. The COPD Alliance provided a grant that offers free access to clinicians and enables site hosting and tool kit updating. The TDTTK was called a tool kit, rather than a guideline or standard, because its creators wanted to emphasize its user-friendly format and ease of use in a practitioner’s office. The current version incorporates the most modern, evidence-based information, including multiple medications to stop smoking.
An asthma model was used to create these protocols, which provide physicians with ways to escalate or de-escalate medications.
“Our philosophy,” said Dr. Prezant, “was to take information and put it into a model that physicians can use immediately without any barriers when they encounter a ‘reachable, teachable moment.’ It is not that physicians don’t ask patients if they are smoking or if they want to stop. The problem is that we don’t ask them every time we see them. We need to find out if anything in the household has changed and offer tobacco cessation in a way that is understandable.” He explained, “For example, if a family member has just died of cancer or if a child is missing school due to asthma, these are reachable, teachable moments.”
“I recognize that I play an important role in my patients’ continued smoking,” said Frank T. Leone, MD, FCCP, a pulmonologist who uses this tool. “The better I am at tearing down obstacles, the more likely my patients will be to benefit from abstinence. It is less about using a particular drug or reciting a particular phrase and more about finding a way to make a small, incremental, cumulative impact on my patients’ health. This means finding a way to do this within the context of a busy practice. I am successful when I help people put down their cigarettes with some degree of confidence or when I help a patient who is initially resistant become more open to discussion or committed to trying to quit. “
Dr. Leone finds the part of the tool kit that most helps him in his practice is the section on billing. However, he added, “The part of the tool kit that helps the most in the circumstance of patients with COPD and their feeling of hopelessness is the material on the nature of addiction. By explaining the impact of nicotine on the brain and behavior, it becomes possible to instill some hope back into the situation and outline a clearly defined plan for dealing with the obstacles they face.“
Using the tool kit, the FDNY has experienced outstanding success rates for smoking cessation. “We are in our 11th year and repackaging the program to make it seem new for those who didn’t participate or did not do well,” said Dr. Prezant. “We identify success when someone stops smoking and stays off cigarettes, or for those who are unable to stop, the appropriate reattempt to stop. We feel there are no failures, only failed attempts. “
Now you can help your patients stop smoking and be reimbursed using the protocols and coding information contained in this comprehensive tool kit.