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

Jim McCord, Project Director Tobacco Control Program SD DOH 615 E. 4th 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 1st, 3rd, 4th, and 5th 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 1st, 3rd, and 5th 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 (1st call to QuitLine by a participant to enroll in program): 10-15 minutes 1st coaching session: 25-45 minutes 2nd-4th coaching sessions: 15-20 minutes 5th 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 Perce nt n Experienced unpleasant side effects 26% 413 Ran out of medication 12% 193 2% 36 Medication didn’t work Reasons unrelated to medication 60% Reasons Chantix users were not able to stay quit (n 838) Reason Perce nt n 10% 84 Ran out / Couldn’t afford / Couldn’t get medication 5% 43 Didn’t like / Couldn’t use medication 5% 40 Medication didn’t help

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.

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

SD QuitLine Timeline 2005 2006 2007 2008 13mo quit rate (7dpp): 29% 26% 38% N/A