FACTORS CONTRIBUTING TO BUCKLEY’S TOBACCO QUIT RATE (62%) 1. We base our program on a research based, scientific system – QuitSmart QuitSmart was developed by Robert Shipley, Ph.D of the Duke Stop Smoking Program. The system is comprehensive and addresses virtually all roadblocks to quitting (see the “Military Intervention Protocol” attachment, compliments of Dr. Shipley). This Protocol gives a thorough overview of the QuitSmart program. The QuitSmart system is being used at several AFB’s (See attachment for list of bases/VA facilities). We recommend the manual ($75) and the QuitSmart Leader Certification Training ($150 – Dr. Shipley teaches it himself); the manual can be ordered by calling 888-737-6278 or check out www.QuitSmart.com for more information. 2. We use a single facilitator for our program. MSgt Sharon Tracey and TSgt Rose Tapnio are the facilitators for our program. Besides Sharon’s expertise in smoking cessation principles and counseling skills, we feel this practice offers an additional measure of trust and support for our customers during the quitting process. Customers know that Sharon will personally counsel and support them at each appointment and will be the one performing their follow up. 3. Our smoking cessation counseling is performed on a one-on-one basis. All of our counseling sessions are performed one-on-one with the exception of seeing customers in a group setting on their quit date, if dates happen to coincide (we actually encourage a group meeting on their quit date if individuals work together - fosters support). The flexibility of individualized scheduling lets us get clients in our program right away. We are usually able to get them in for their first session within a few days; often we see them the same day! We feel this offers advantages over having them wait for a scheduled class weeks away. Individualized counseling makes a positive difference. If you have the manpower and time, we highly recommend it! 4. We offer NRT and Zyban to our customers We have a very good working relationship with our clinic providers. They are very liberal in prescribing medications if the customer chooses to use them (we highly encourage pharmacotherapy unless contraindicated). Most of our clients receive 8 weeks of NRT and 8 weeks of Zyban. For hardcore folks who smoke and chew, we often prescribe the patch, gum and Zyban. Our providers are flexible and will extend Zyban therapy if indicated. If the customer agrees to use pharmacotherapy, they have already seen their PCP to obtain their prescription before they enter our program. We counsel them on NRT and Zyban use, countersign and stamp the prescription so they can take back to pharmacy to get it filled. Clients must see us before pharmacy will dispense their medications. 5. We use a variety of contracts (see the “Buckley Forms” attachment). Lots of programs use contracts and so do we. We utilize a support contract (taken from the QuitSmart Program) and mail it to the customer’s significant other, friend or a co-
worker who they have identified for this purpose. The contract outlines ways to help support the client in becoming tobacco free. We request they sign the contract and mail it back to us. MSgt Tracey includes a self-addressed envelope. (We get approximately a 60% return rate with them having to supply the stamp! We are in the process of getting metered envelopes which will surely improve the return rate). Additionally, each client signs a “Stop Smoking Contract” at the beginning of our program (included in the “Buckley Forms” attachment). 6. Our program consists of 4 face-to-face sessions and 3 phone follow-ups. TIMELINE SESSION Initial appointment 1-4 weeks later (usually 2weeks) 2 (Quit date) 2 days later 2 weeks later 1 month later Phone follow-up #1 2 months later ( i.e. 3 months after the Phone follow-up #2 final face-to-face session, usually session #4) 6 months after session 1 Phone follow –up #3 * See the “Military Protocol Intervention” attachment for specific content covered in the various sessions.
7. We have a high success rate for contacting people at the 6-month follow-up. This may be partially due to a fairly stable base population, but here’s what we do. 1) At the initial appointment we ask for plenty of personal contact information including: work phone, home phone, cell phone and e-mail addresses. 2). Initial contact at the 6 month point is attempted by phone; if unsuccessful MSgt Tracey will send them an e-mail (the majority of our responses are through e-mail. All they have to do is answer the question with a simple “yes” or “no” response and hit send). If these two attempts fail to generate a response, a final phone call is made to attempt contact. During our initial counseling session we try to get a permanent phone contact number (parents, relative or friend that the client talks to on a regular basis) in case of PCS. As you know, if we can’t contact them for follow-up, we must count them as a tobacco user. If you decide to use this method for increasing the odds of successful follow-up, be careful to not disclose that the customer was in a tobacco cessation program. We have had customers who did not want a support contract mailed to a family member because the family member was unaware that the individual used tobacco.
General Comments about Buckley’s Program:
• The core content covered in our four face-to-face sessions is taken from the
QuitSmart System Implementation Guidelines (OuitSmart Manual). MSgt Tracey has customized our program by adding a couple assessment questionnaires that she finds useful in assessing the client’s addiction (“Test Yourself” form), in screening for depression (“Self Assessment” form), and for showing the clients how they have progressed through the program (“Smoke Screen” questionnaire). They complete the Smoke Screen questionnaire at the first and last session. (Each of these forms are included in the “Buckley Forms” attachment)
• Although the “Military Protocol Intervention” attachment describes group
intervention, the content essentially mirrors the individual intervention that we use.
• We closely follow the QuitSmart system with the exception of medication
dispensing. Our clients receive their NRT from pharmacy prior to their quit date, although they are instructed not to use NRT until their quit date. Medications are dispensed in 2-week amounts by our pharmacy. If a customer fails to attend the classes, TSgt Tracey notifies pharmacy and pharmacy will not refill the prescriptions.
• Research literature suggests a dose-response relationship between number of sessions
and treatment efficacy, with greater than 8 sessions offering the highest efficacy (although the difference in treatment efficacy between 4 to 8 sessions and more than 8 sessions is not significant). Our experience is that 4 sessions seems to be an optimum number of sessions for most of our clients. More than 4 sessions makes it difficult for many people to attend. MSgt Tracey encourages and provides additional sessions to individuals who need additional support.
• Although we use a single facilitator for our formal tobacco cessation counseling, 3 of
us are certified QuitSmart Leaders. When someone contemplating quitting enters our HAWC, we never miss an opportunity to give them some attention and provide them with information.
If you have questions about our program, please feel free to call MSgt Sharon Tracey, DSN 847-6864
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