Jim McCord, Project Director Tobacco Control Program SD DOH 615 E. 4 th St.

Pierre, SD 57501 Phone: (605) 773-3737 Fax: (605) 773-5942 Email: [email protected]

SD QuitLine Offers:

 Free written materials to assist tobacco users who are ready to quit  Free telephonic cessation counseling delivered by trained health coaches  Access to free cessation medication  Referrals to other cessation services (if interested)

Eligibility Requirements

 Must be a resident of the state of South Dakota  Must be a current tobacco user ready to quit

3 Opportunities

 Those participants who have previously used the QuitLine but have relapsed may call up to a total of 3 times in their lifetime  Eligible 3 months after their last date of service with the QuitLine

QuitLine Medications

 Up to 8 weeks of:   Nicotine Replacement Patch Nicotine Replacement Gum  Up to 12 weeks of:   Zyban Chantix

Medication Descriptions

 Zyban (Generic Name: Bupropion)  Non-nicotine containing prescription drug that reduces the symptoms of nicotine withdrawal by acting on the chemicals in the brain related to nicotine craving  Chantix (Generic Name: Varenicline)  Non-nicotine containing prescription drug that reduces the urge to smoke by preventing nicotine from reaching the key nicotine pleasure receptors in the brain

Over-the-Counter Medication: Patch, Gum

 Individual must call the QuitLine to enroll in the program  Participant receives letter & member ID # with explanation of how to pick up at a local participating pharmacy  Pick up 2 weeks patch or gum at a time: coach approves in 2 week increments after 1 st , 3 rd , 4 th , and 5 th coaching sessions

Prescription Medication: Zyban, Chantix

 Individual must call the QuitLine to enroll in program  Healthcare provider determines the medication is safe and appropriate for individual  Healthcare provider faxes a QuitLine prescription form to Central Pharmacy  QuitLine coach sends Central Pharmacy notification of completion of 1 st , 3 rd , and 5 th coaching sessions  Medication is sent to participant’s home address

Must Enroll & Participate in Coaching

In Order To Receive Free Cessation Medication  Typically 5 coaching sessions centered around a Quit Date  Sessions scheduled by the participant at their convenience  QuitLine Coach calls the participant at scheduled time

Approximate Length of Coaching Sessions

 Initial Call (1 st call to QuitLine by a participant to enroll in program): 10-15 minutes  1 st coaching session: 25-45 minutes  2 nd -4 th coaching sessions: 15-20 minutes  5 th coaching session: 10-15 minutes

Coaching Sessions 1 & 2

Preparation (Prior to Quit Date)  Develop a Personalized Quit Plan  Plan a Quit Date  Medication Information  Discuss:    Triggers Coping Mechanisms Withdrawal Symptoms

Coaching Session 3

On Quit Date  Coach Provides Support and Encouragement  Addition Information on Medication

Coaching Session 4

After Quit Date  Follow-Up  Review Quit Strategies  Address Relapses

Coaching Session 5

Graduation Session  Contact Information  Graduation Letter Issued  Leave with any Last Suggestions  Answer Questions

QuitLine Hours of Operation

 Monday-Friday: 7:00 am – 11:00 pm  Saturday: 8:00 am – 5:00 pm  Sunday: 10:00 am – 4:00 pm Voicemail available 24 hours/day with a return call within 24 hours

Challenges with Chantix

 Reasons Chantix users stopped using the medication (n= 1,614)

Reason

Experienced unpleasant side effects Ran out of medication Medication didn’t work

Reasons unrelated to medication

Percent

26% 12% 2%

60%

n

413 193 36  Reasons Chantix users were not able to stay quit (n=838)

Reason

Medication didn’t help Ran out / Couldn’t afford / Couldn’t get medication Didn’t like / Couldn’t use medication

Reasons unrelated to medication

Percent

10% 5% 5%

80%

n

84 43 40

Challenges with Chantix

 The provider sends the Rx to the pharmacy, but client never calls the QL to initiate cessation coaching.

 When the Rx does not reach the pharmacy, it results in a delay in med distribution.

 Rx scripts are signed but incomplete, illegible or wrong medication amount prescribed.

 Rx scripts are faxed to local pharmacy rather than central pharmacy.

 Lack of follow through from provider (no fax sent).

Successes with Chantix

 Rx mailed directly to participant’s home SD address, no need to go to pharmacy which is critical in rural areas.

 Central pharmacy tracks amount of Rx received by participant so as not to exceed 3-month supply.

 Ease of QL client in receiving Rx through the mail and coaching over the phone (no travel).

 Physician referrals increased to 44% of all QL callers.

 Quit Rates have significantly improved.

Data from 7 month follow-up evaluations: January-August 2008

 74% (n=1,614) of coaching participants used Chantix - 2% of these participants also used NRT (n=29)  89% of Chantix users reported that it was “very easy” to get the medication  Quit rates are significantly higher for 2008 than for previous years.

Medication Requests

 In 2008, 69% of callers who requested coaching wanted to use the prescription medication, Chantix.

100% 80% 60% % of callers 40% 20% 0% Percent of medication requests by type in 2008

69%

Chantix

5%

Zyban

13%

NRT (Patches or Gum)

Enrollment

 SD QuitLine use increased nearly three-fold in 2008.

# of callers Total # of intake calls and callers who requested coaching, 2005 2008 12000 8000

9571 9264 3836 3080 3900

Intake calls Requested coaching 4000

3123 2520 3209

0 2005 2006 2007 2008

SD QuitLine Timeline

2005 2006 2007

13mo quit rate (7dpp): 29% 26% 38%

2008 N/A