Rural Clinic Uses Technology to Treat Tobacco Use

If you drove over the hills and through the valleys leading to Scenic Bluffs Community Health Centers in rural Cashton, Wis., you’d expect to pass the tractors, trees and Amish horse carts. But you might be surprised to find a clinic that implements the latest technology to help patients quit smoking.

For example, Scenic Bluffs enrolls patients who want to quit in the Fax to Quit program, which links smokers and chewers to free, compassionate help with quitting from the Wisconsin Tobacco Quit Line. Patients choose the date and time to have a Quit Line coach call them to set a quit date and formulate a plan for success. It works well for rural patients who, in some cases, travel quite a distance for a medical visit.

From Left: Kris Hayden, UW-CTRI outreach specialist; Tiffany Giesler, school nurse and tobacco-treatment coordinator; Anne Heath, health communications coordinator; Dr. Joel Erickson.

Doctors and dentists at the clinic also prescribe the latest FDA-approved medications to quit smoking, including Chantix, a new pill designed to block cravings and ease withdrawal. This combination of provider intervention, medication and coaching is the bedrock of the U.S. Public Health Service’s Clinical Practice Guideline: Treating Tobacco Use and Dependence. Scenic Bluffs is proof it works as well in the country as it does in big cities.

Medical Director Dr. Joel Erickson said the clinic’s tobacco treatment took off when they designated Tiffany Giesler, a school nurse, to coordinate the program. Selecting a champion is another recommendation from the Guideline.

“Our goal is to ask everybody that comes in for a medical or dental visit about tobacco use and exposure,” Giesler said. “Then, we offer assistance and refer to the Quit Line.”

Giesler said everything doesn’t always go smoothly. “The biggest roadblocks are finding the time, dealing with turnover and training new staff.” But Giesler has helped the clinic to weave both aspects into the everyday routine. The clinic is moving to electronic medical records, and Erickson said the ability to easily document tobacco status in files should only improve the systematic nature in which they help patients to live smoke-free.

Dr. Erickson said tobacco treatment isn’t as complicated or overwhelming as it might seem. “The first thing is you just have to ask. I’d say, we have a program if you’re interested in quitting.” Erickson doesn’t hesitate to prescribe medications or bill using the 305.1 code for tobacco treatment. It doesn’t take long, he said, because he can quickly refer patients to Anne Heath, health communications coordinator. Heath follows up, offers materials on how to quit and links patients to the Quit Line. She said it’s nice to have a free service like the Quit Line to save time and money.

And saving money is a big deal to their 6,400 patients—about 96 percent are well below the federal poverty level. Almost 40 percent are Medicaid enrollees and about 30 percent are uninsured. Scenic Bluffs offers a sliding payment scale at both of its sites.

As a family physician, Erickson said it’s important to care for the most vulnerable, including children. As part of the Healthy Air for Kids program, Scenic Bluffs staff discuss tobacco use with parents who smoke, even if they say they don’t smoke around the kids. They offer brochures specifically designed for parents who smoke, provided free of charge by the UW Center for Tobacco Research and Intervention (UW-CTRI).

“I ask parents if they’ve thought about quitting,” Erickson said. “We also educate on how chemicals from the smoke linger.” Research shows tobacco smoke contains 4,000 chemicals. These deadly byproducts remain for hours in drapes, upholstery, clothes, hair and vehicles.

UW-CTRI Outreach Specialist Kristine Hayden has provided free training, materials and technical assistance on best practices to help improve the clinic’s tobacco treatment.

“That had an impact on my behavior in my clinical practice,” said Dr. Erickson. “When I enter the patient room I think about it.”

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