January 2001

Grant Results

SUMMARY

This project included three activities in conjunction with the April 1996 release of the federal Agency for Health Care Policy and Research (AHCPR) Smoking Cessation Clinical Practice Guideline. The activities were:

  • A two-day conference on policy issues critical to the dissemination and adoption of the Guideline among health care providers and health plans.
  • Communications support for the conference.
  • Preparation and publication of the proceedings from the conference.

Key Results

  • Cosponsored by RWJF, the federal Centers for Disease Control and Prevention Office on Smoking and Health (OSH), and the National Cancer Institute (NCI), the conference, "AHCPR Smoking Cessation Guideline: Its Goals and Impact," was held in Washington, September 17–18, 1996.

    It drew more than 250 registrants, including public health officials, representatives of pharmaceutical companies with tobacco dependence treatment products, and decision-makers from managed care and health delivery systems.

    The conference included:
    • A review of the Guideline.
    • Perspectives on the Guideline from representatives of various smoking cessation constituencies, such as physicians, employers, and consumers.
    • A discussion of implementation/dissemination issues.
    • An exploration of potential outcomes by which to measure the impact of the Guideline.

Promotion of the conference and the Guideline in the media resulted in coverage in various national and health-related publications and media outlets. Conference proceedings were published in a special supplement of the Autumn 1997 issue of Tobacco Control, an international, peer-reviewed journal.

Funding
The Robert Wood Johnson Foundation (RWJF) supported the project with three grants totaling $116,956.

RWJF also awarded six grants to support the dissemination of the Guideline, including grants to the Medical College of Wisconsin (Madison, Wis.) and five professional health organizations representing gynecologists, cardiopulmonary specialists, women physicians, pediatricians, and nurses (see Grant Results on ID# 029389, etc.).

The conference and the related communication activities were part of a multi-phase RWJF strategy to encourage the use of the Guideline and to address any policy-related and institutional barriers to systematic smoking cessation treatment.

 See Grant Detail & Contact Information
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THE PROJECT

Tobacco use is one of the most serious common health problems in the United States, yet access to effective treatment remains limited for most Americans. Over 70 percent of smokers see a physician each year, but only about one-third of those receive any medical advice or assistance on quitting.

The federal Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline on Smoking Cessation, released in April 1996, provides a new tool to widen access to treatment for smokers and smokeless tobacco users who say they want to quit.

The Guideline aims to motivate health care providers and health plans to routinely offer effective treatments. The Guideline emphasizes brief cessation treatments that can be easily incorporated into routine medical practice (including guidelines for the additional use of nicotine replacement therapies and special guidelines for the treatment of pregnant smokers, adolescent smokers, and smokeless tobacco users). It also identifies the need for health care systems to make organizational changes that will result in the systematic identification of, and regular intervention with, all tobacco users at every visit.

This project, supported by three grants from RWJF, comprised three activities in conjunction with the April 1996 release of the Guideline:

  1. Planning and oversight for a two-day conference on policy issues, such as screening to identify the tobacco-use status of patients, that are critical to the dissemination and adoption of the Guideline among health care providers and health plans.
  2. Communications support for the conference.
  3. Preparation and publication of the peer-reviewed proceedings from the conference.

The conference and the related communication activities were part of a multi-phase RWJF strategy to encourage the use of the Guideline and to address any policy-related and institutional barriers to systematic smoking cessation treatment in the health care system.

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RESULTS

  • Pinney Associates, a health care consulting firm, assembled a Conference Planning Committee to plan, organize, and conduct a two-day conference to be held in Washington, D.C. (Grant ID# 027474). The conference, "AHCPR Smoking Cessation Guideline: Its Goals and Impact," held September 17–18, 1996, had 250 registrants, including public health officials, representatives of pharmaceutical companies with tobacco dependence treatment products, and several decision-makers from managed care and health delivery systems. Attendance was 40 percent higher than expected. (The conference was formally convened by the Society for Research on Nicotine and Tobacco, a nonprofit organization conducting research on nicotine, tobacco, smoking, and smoking cessation.) OSH, NCI, and RWJF served as cosponsors of the conference. NCI contributed $30,000 in in-kind travel support to presenters and planning committee members; OSH provided a $30,000 conference support grant covering office expenses (such as printing and mailings) as well as the speakers' fees. A planning committee assisted Pinney Associates in organizing the conference.

    The conference featured:
    1. A detailed review of the Guideline.
    2. Presentations of perspectives on the Guideline from representatives of the smoking cessation/prevention research community, the public health community, health delivery systems (including managed care and hospitals), insurers, advocates for medically underserved communities, federal and state governments, and the commercial sector with interests in smoking cessation, such as the pharmaceutical industry.
    3. Discussion of the implementation/dissemination issues around the Guideline.
    4. Suggestions of potential outcomes by which to measure the influence and impact of the Guideline. (See the Appendix for list of Conference Planning Committee members, and the Bibliography for list of speakers and topics.)
  • Burness Communications, a media and public relations consulting firm, provided communications support for the two-day conference to increase the potential for adoption of the Guideline as a tobacco use cessation tool (Grant ID# 030308). Burness:
    1. Distributed a media advisory in advance of the conference to reporters throughout the Washington area and selected media outlets in the United States.
    2. Promoted the conference and the Guideline to various "specialized" press representatives (health insurance and managed care publications) and to mainstream outlets (news wires, news bureaus, Washington Post, etc.).
    3. Prepared media kits and answered press queries and on-site interviews at the conference.
    4. Prepared a news story immediately following the conference that was sent by news wire to every major news outlet in the United States and to a list of specialized health media, and responded to several press calls the story generated.
    5. Prepared an opinion piece on behalf of Michael Fiore, M.D., chair of the AHCPR Smoking Cessation Guideline Panel, the advisory panel to the AHCPR initiative.

    Burness was not able to place the piece in a major metropolitan newspaper, as planned. The article was published in American Medical News, the official news publication of the American Medical Association.
  • Pinney Associates oversaw the preparation, publication, and initial dissemination of conference proceedings (Grant ID# 030465). The proceedings were produced as a special supplement to the Autumn 1997 issue of Tobacco Control, an international journal published by the BMJ Group, an international publisher of scientific journals, papers, and articles on health. The supplement was sent with a cover letter to all registrants to the conference, the 1,000 subscribers to Tobacco Control, and tobacco control researchers, public health officials, state and federal policymakers, professional associations, and managed care leaders. RWJF funds covered the cost of publishing the supplement, and administrative oversight expenses. OSH and NCI each contributed $7,500 for distribution and other expenses.
  • Major findings and recommendations of the conference proceedings, as published in a supplement to the Autumn 1997 issue of Tobacco Control, include:
  1. Effective smoking cessation treatments are available, and every patient who smokes should be offered one or more of these treatments.
  2. It is essential that clinicians determine and document the tobacco-use status of every patient treated in a healthcare setting.
  3. Brief cessation treatments are effective, and at least a minimal intervention should be provided to every patient who uses tobacco.
  4. A dose-response relation exists between the intensity and duration of a treatment and its effectiveness. In general, the more intense the treatment, the more effective it is in producing long-term abstinence from tobacco.
  5. Three treatment elements, in particular, are effective, and one or more of these elements should be included in smoking cessation treatment:
    • Nicotine replacement therapy (nicotine patches or gum).
    • Social support (clinician-provided encouragement and assistance).
    • Skills training/problem solving (techniques on achieving and maintaining abstinence).
  6. Effective reduction of tobacco use requires that health care systems make institutional changes that result in systematic identification of, and intervention with, all tobacco users at every visit.

Communications

News about the Guideline generated at the conference was reported in various print, radio, and television media outlets, including the Washington Post, Reuters news service, Channel 4 News in Washington, D.C., and various health-related publications (See the Bibliography). The proceedings of the conference were published in the Autumn 1997 issue of Tobacco Control, as noted in Results.

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AFTER THE GRANT

These grants were part of a larger RWJF strategy, which included support for the dissemination of a short version of the Guideline, called the Pocket Guide, to primary care providers who have contact with patients who smoke (see Grant Results on ID# 029466). Shortly after the conference, RWJF made a set of grants to professional health organizations to promote to its members the use of the pocket guide as a smoking cessation treatment tool. These organizations were: Medical College of Wisconsin (ID# 029389) to oversee the project; American Academy of Pediatrics, Inc. (ID# 030329); The American College of Obstetricians and Gynecologists (ID# 030520); American Medical Women's Association, Inc. (ID# 030375); American Nurses Foundation, Inc. (ID# 030254); and Creighton University (ID# 030525) to promote it to cardiopulmonary specialists. (See Grant Results on ID# 029389, etc.)

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GRANT DETAILS & CONTACT INFORMATION

Project

AHCPR's Smoking Cessation Guidelines: Conference and Proceedings

Grantee

Pinney Associates, Inc. (Bethesda,  MD)

  • Conference on Policy Issues Related to Implementation of AHCPR's Clinical Practice Guideline on Smoking Cessation
    Amount: $ 64,478
    Dates: February 1996 to November 1996
    ID#:  027474

Contact

John M. Pinney
(301) 718-8440

Grantee

Burness Communications, Inc. (Bethesda,  MD)

  • Communications Support for a Conference on AHCPR's Smoking Cessation Guideline
    Amount: $ 16,978
    Dates: September 1996 to January 1997
    ID#:  030308

Contact

Andrew I. Burness
(301) 652-1558

Grantee

Pinney Associates, Inc. (Bethesda,  MD)

  • Preparation of Proceedings from the Conference on AHCPR's Smoking Cessation Guideline
    Amount: $ 35,500
    Dates: October 1996 to March 1998
    ID#:  030465

Contact

John M. Pinney
(301) 718-8440

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Conference Planning Committee

Michael Fiore, M.D., Chair
University of Wisconsin
Madison, Wis.

Ronald M. Davis, M.D.
Henry Ford Health System
Detroit, Mich.

Michael Goldstein M.D.
American Psychiatric Association
Washington, D.C.

Jack Henningfield
National Institute on Drug Abuse
Washington, D.C.

Saul Shiffman, Ph.D.
University of Pittsburgh
Pittsburgh, Pa.

Maxine Stitzer, Ph.D.
Johns Hopkins University
Baltimore, Md.

Daniel B. Wolfson,
The HMO Group
Washington, D.C.

Ex Officio
Timothy Baker, Ph.D.
University of Wisconsin
Madison, Wis.

C. Tracy Orleans, Ph.D.
Robert Wood Johnson Foundation
Princeton, N.J.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Davis, RM (ed.). "AHCPR Smoking Cessation Guideline: Its Goals and Impact." Tobacco Control, 6(Suppl. 1): 1997. Contains the proceedings of the national United States conference convened by the Society for Research on Nicotine and Tobacco.

Sponsored Conferences

"AHCPR Smoking Cessation Guideline — Goals and Impact," September 17–18, 1996, Washington, D.C. 250 registrants, including public health officials, representatives of pharmaceutical companies with nicotine replacement products, and several decision-makers from managed care and integrated health delivery systems. 21 presentations and five panels.

  • C. Tracy Orleans, "Welcome."
  • Douglas Kamerow, "Introduction."
  • Michael Fiore, "The AHCPR Guideline — A Fundamental Review."

Successful Implementation — Prerequisites and Barriers

  • Stuart Cohen, "Barriers to Changing a Health System's Approach to Tobacco Dependence."
  • Tom Simmer, "Challenges of Guideline Implementation in an HMO."
  • Jasjit Ahluwalia, "Reaching the Medically Underserved."

Making it Work: Examples from the Field

  • Carlos Roberio Jaen, "Primary Care Physicians."
  • Tony Tommasello, "Pharmacists."
  • Linda Lillington, "Nurses."
  • Ed Lichtenstein, "Psychologists."

Stakeholder Reactions

  • A. Stuart Hanson, "HMOs/Health Systems."
  • D'Ann Whitehead, "Purchasers/Employers."
  • Yank Coble, "National Perspective on Guidelines."
  • Carol Cronin, "Consumers."

Other Aspects of Changing Provider Behavior

  • Judith K. Ockene, "Provider Training."
  • John M. Eisenberg, "Medical Education/Academic Detailing."
  • Ronald M. Davis, "Report Cards (HEDIS, FACCT)."

Financing and Reimbursement Issues

  • Helen Halpin Schauffler, "Overview."
  • Daniel Pitts Winegarden, "State Reaction."
  • Cathy L. Melvin, "Public Health Perspective."
  • Robert Jeddeloh, "HMO Perspective."

Press Kits and News Releases

An advance Media Advisory was sent along with an agenda announcing the conference to reporters throughout the Washington area and selected US media outlets.

"Health Care Providers Can Help Smokers Quit. But Will They?" News story prepared by Burness Communications was sent on PR Newswire September 23, 1996 to every major news outlet in the United States and a specialized health list. The article generated several press calls.

"It's Time to Treat Smoking Like a Vital Sign — and Ask." Michael Fiore. Op-Ed prepared by Burness Communications. American Medical News, July 21, 1997.

Print Coverage

"Want to Quit Smoking? Call Us, Psychiatrists Say," in Reuters North American Wire, September 19, 1996.

"Doctors Seen Ignoring Urine Test for Nicotine," in The Washington Post, September 21, 1996.

"Smoking Cessation Therapy Most Effective Preventive Intervention Available," in The Tan Sheet (FDC Reports), September 23, 1996.

"AHCPR Encourages Physicians to Help Smokers Kick Habit," in Managed Care Outlook, October 3, 1996.

"Proponents of Smoking Cessation Press MD Intervention," in Medical Utilization Management, October 3, 1996.

"Clearing the Air," Healthplan, November/December 1996

"Tobacco Legislation S. 1415 Moves Ever So Slowly through the Senate," in the AACP Government & Health Policy Bulletin, June 1998.

Mass Media

"News Four at 9." Interview with Michael Fiore, M.D., about smoking cessation, Washington, D.C., September 18, 1996.

"WTOP-AM News," Michael Fiore interviewed by phone, Washington, D.C., September 18, 1996.

"Canadian Broadcasting Company," 15-minute interview with Michael Fiore, M.D., and others (place and date unknown). Fed to Cox media outlets including those in Atlanta, San Francisco, Dayton, and Seattle.

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Report prepared by: Kelsey Menehan
Reviewed by: David Kales
Reviewed by: Janet Heroux
Program Officer: C. Tracy Orleans

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