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 1. Home
 2. Policy & Advocacy
 3. Tobacco Initiatives
 4. Smokefree Environments
 5. Expanding Smokefree Communities
 6. Making Tobacco Cessation a Priority at the Free Medical Clinic in Columbia,
    South Carolina


MAKING TOBACCO CESSATION A PRIORITY AT THE FREE MEDICAL CLINIC IN COLUMBIA,
SOUTH CAROLINA

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RECOGNIZING THE NEED

For more than 30 years, The Free Medical Clinic in Columbia, South Carolina has
provided quality medical care to uninsured members of the community, at no cost.
The clinic offers primary care, medications and referrals to specialists. Now,
they offer one more service: tobacco cessation counseling and resources.

The need for cessation resources was great. 42 percent of patients who visit The
Free Medical Clinic use tobacco, twice the average among South Carolina
adults.1,2

Dr. Todd Krump, medical director of The Free Medical Clinic, has seen how
tobacco use negatively impacts the health of his patients. A third of the
clinic's patients have diabetes and ten percent have heart disease, two chronic
conditions related to tobacco use.1

Melissa Goforth, Area Manager of the American Lung Association in South
Carolina, also notes the financial drain tobacco puts on the clinic's patients.

"Tobacco most impacts those who can afford it the least. It is a huge economic
burden for the patients. To be a patient at this clinic, an individual can only
make $16,100, a family of four can make no more than $33,000 a year. Tobacco is
robbing these patients of income they need," she said.

To encourage patients to quit tobacco, The Free Medical Clinic made its own
grounds smokefree. Goforth says this makes the clinic a supportive place for
those interested in quitting and reinforces the idea that healthy environments
are smokefree environments.

"One of the first things I had to show was that this was systems change. We were
working towards long-term, sustainable change in the way patients, staff and
volunteers address tobacco," she said.

Download PDF


ADMINISTRATIVE MOVEMENT

The Free Medical Clinic needed to identify and track the tobacco status of its
patients in order to connect patients with cessation resources. However,
existing systems to track tobacco use depended on electronic medical records and
the clinic still uses paper records. Creating a separate paper form for tobacco
use would add paperwork and increase waiting times. This had stopped similar
clinics from tracking tobacco use in the past but the staff at The Free Medical
Clinic employed creative problem-solving.

They devised a labeling system using easy and efficient stickers. Any clinic can
implement this regardless of resources." - Melissa Goforth, Area Manager of the
American Lung Association in South Carolina


BRIEF, CONSISTENT INTERVENTIONS

Another piece of the systems change effort at The Free Medical Clinic was
designing tobacco interventions with the patients. These interventions had to be
brief since there's a high demand for the clinic's services. Lengthy
interventions would reduce the number of patients the clinic could serve in a
given day. Intervention methods also had to be easy for staff to learn. Like
most similar clinics, The Free Medical Clinic has few permanent staff and relies
heavily on volunteers and medical students. New staff must be trained quickly in
order to keep everything running efficiently.

When a patient is first identified as a tobacco user, a physician's assistant
conducts a brief assessment. While that takes staff time, one-on-one counseling
increases the likelihood of quitting smoking. Of course, most patients are not
ready to quit after a single assessment so multiple interventions are planned.

"For most patients who quit tobacco, it is a process, not a single decision.
Just asking them to quit once isn't as effective as it could be. By asking at
every visit, clinic staff help patients move towards a quit attempt. When they
are ready, they help patients set a quit date and get them free patches or
lozenges. Afterwards, they check in to see how they are doing," said Goforth.

Interventions need to take place at appointments since the patients often change
addresses and phone numbers and it can be very difficult to reach them between
appointments.

While all of the intervention methods selected by Goforth and The Free Medical
Clinic were evidence-based, Volunteer Coordinator Sandy Earles wanted to test
them out as she was a smoker herself.

"I tried to quit a few times in the past but it never worked. I tried out the
methods we were going to use with patients, tracking how much I was smoking and
working up to a quit date. Now, I haven't smoked in over a year," said Earles.

Earles is now responsible for training volunteers and students on the tobacco
intervention strategies and uses her own example as a success story. Earles has
become a champion for The Free Medical Clinic in changing the system of how
tobacco users are identified and provided with resources to successfully quit.


SUSTAINABILITY AND GROWTH

Dr. Krump and the rest of the staff at The Free Medical Clinic are pleased with
the changes they made. Their tobacco intervention is sustainable and they
believe it will reduce chronic disease rates among their patients.

Goforth hopes other free clinics follow the example set by The Free Medical
Clinic. She knows the systems they set up – smokefree grounds, tracking tobacco
use and brief interventions – are low-cost and manageable for any free clinic.
She is also willing to share her experience with any free clinic that wishes to
make a similar change.

Goforth is hopeful that the medical students who spend a rotation at The Free
Medical Clinic will pass on the work as they move forward in their careers.

"The medical students who trained with us will go on to work all over the
region. That's a lot of new doctors who understand the importance of brief
tobacco interventions and know how to conduct them," she says.

"Our mission is to provide quality healthcare. Tobacco cessation and prevention
is a critical part of that mission." -Dr. Todd Krump.
 * References

 1. http://www.freemedclinic.org/wp-content/uploads/2014/07/Doctors-Lounge-2014-Sponsor-Information-Packet.pdf

 2. King BA, Dube SR, Tynan MA. Current Tobacco Use Among Adults in the United
    States: Findings From the National Adult Tobacco Survey. AJPH, Nov 2012;
    102(11):e93-e11.

Page last updated: September 10, 2024

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