Smoking Cessation in Orthopaedic Trauma: Feasibility and Pilot Program (1500325B)

The cessation landscape has changed considerably since the last Centers for Disease Control and Prevention (CDC) Best Practices-2007 and with the release of the updated version of the Public Health Services Clinical Practice Guideline, Treating Tobacco Use and Dependence, in 2008. These changes have presented significant new opportunities to expand cessation coverage, institutionalize tobacco use screening and interventions within health care systems, and increase the availability and use of evidence-based cessation treatments. Due to these changes, the CDC has recommended the flowing strategies for Cessation Interventions: promoting health systems change, expanding insurance coverage and utilization of proven cessation treatments, and supporting state Quitline capacity. The Center for Tobacco Prevention and Control's (CTPC) goal is to engage health care systems to improve the delivery of guideline-concordant care for tobacco dependence through systems and policy change at the organizational level. CTPC shall assist health care provider organizations with instituting system level tobacco dependence treatment policies that will lead to population based outcomes such as increase the percentage of adults smokers who were assisted in quitting smoking by a healthcare professional with evidence based tobacco dependence treatment, increase number of healthcare organizations that provide tobacco screening systems for all of their networks, and increase the number of healthcare organizations that provide tobacco treatment dependence provider training, resources, and feedback. Referrals to the evidenced based Maryland Tobacco Quitline provide a unique opportunity to extend providers' capacity and make evidence-based effective care available to Marylanders. CTPC has successfully managed the Maryland Tobacco Quitline (QL), 1-800-QUIT-NOW, since 2006, and has a 98% customer satisfaction rate. The QL provides FREE telephone counseling to Marylanders 13 years and older to help them quit tobacco. Services are available 24/7, in English, Spanish, and other languages. Special services are available for pregnant tobacco users and youth. Residents 18 years and older can receive a free supply of Nicotine Replacement Therapy, web, and text support. The Quitline has the opportunity to link their services to providers in the healthcare delivery system and patients who use tobacco. Referral systems are important to health care reform, as they better align public health initiatives with the health care community. Referral systems have been proven successful in driving quitline enrollment and are cost-effective and self-sustaining, once systems have been implemented. The ill effects of smoking and general health are well established. Smoking is associated with increased complications in fracture care (broken bones), including increased infection rate, wound healing difficulties, non-union, and perioperative morbidity. The cost and implications of this are paramount. Recent data also demonstrate that smoking cessation may have a positive impact on fracture care. The psychological effects of trauma may influence a patient's desire to quit smoking. It is unknown if orthopaedic trauma patients represent a group which smoking cessation programs can be effective. The Orthopaedic Trauma Department clinical environment at the University of Maryland Baltimore creates a unique opportunity in which patients are hospitalized, and follow up with fairly regular intervals following discharge, as a standard of care. The goal of this pilot is to provide motivational interviewing coupled with a referral to the Maryland Tobacco Quitline to increase quit rates and attempts among patients from the Orthopaedic Trauma Department at the University of Maryland Baltimore.