Tobacco Control in the Indian Health Care System

July 28, 2011: Cessation: Emerging Interventions and Innovations

Megan Wohr, Tobacco Control Specialist, Indian Health Service

Ms. Wohr began her remarks by providing background on the creation of a National Indian Health Service Tobacco Control Task Force in 2005 that brought together individuals from across the Indian Health Service (IHS) to address the very high rates of tobacco use in the American Indian and Alaska Native populations. As a result of strategic planning undertaken by the Task Force, a "field book" was developed to describe clinical system change to address tobacco dependence treatment. The four major evidence-based actions are: screen everyone for tobacco use and secondhand smoke exposure; educate providers about screening at each visit and relevant tobacco use interventions; help people quit commercial tobacco use by offering treatment services to patients, employees and families and covering the costs of these services; and changing policies including promoting tobacco-free campuses.

Ms. Wohr continued by describing additional resources that were developed including "train the trainer" certification program, provider and patient tool-kits, a speaker's kit and a reimbursement guide for coding and billing . The certification program has been very successful, and since November 2007 over five hundred people have been certified to deliver evidence-based tobacco dependence treatment interventions. Evaluation results from this training program indicate that 88 percent of program participants indicated that they had implemented a system to assess tobacco use with patients at every visit; 80 percent of certification program participants had implemented a system to deliver an evidence-based cessation intervention with patients at every visit; and 76 percent of participants had implemented a practice to document interventions using electronic health records. Ms. Wohr emphasized how critical electronic health records have been to effective systems change and to ensuring continuity of care.

Ms. Wohr concluded by thanking the many federal, tribal, state and local stakeholders and partners with whom the IHS Task Force has worked on this project.

Following Ms. Wohr's presentation, Dr. Riley introduced the next two panelists representing the Centers for Medicare and Medicaid Services.