A decade of experience promoting the clinical treatment of tobacco dependence in Wisconsin.

BACKGROUND The University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) is the designated lead agency at the University of Wisconsin-Madison charged with the responsibility of reducing the harms from tobacco use in Wisconsin and beyond. In 2000, the UW-CTRI, with funding from the state of Wisconsin, launched a population-wide effort--the Wisconsin Cessation Outreach Program (Program)--to increase the availability and use of evidence-based clinical treatments for tobacco dependence. This paper describes the Program's strategies, outcomes, and impact on the clinical treatment of tobacco dependence in Wisconsin. PROGRAM STRATEGIES The Program was designed to change the standard of health care in Wisconsin, so that primary care professionals, and the health systems in which they work, universally identified and intervened with tobacco users. Five primary strategies were used to accomplish its goal: (1) deliver clinic-based and Web-based training and technical assistance for clinicians, including free continuing medical education (CME); (2) provide technical assistance to accomplish health systems' change to support the routine provision of tobacco-dependence treatment; (3) include evidence-based cessation treatment as a covered insurance benefit and reduce other barriers to cessation treatment such as co-pays; (4) provide telephonic tobacco cessation quit line services to all state residents and integrate it with routine medical services; and (5) reduce tobacco-related disparities by increasing access to and use of evidence-based treatment by priority populations. OUTCOMES In the 10 years since the Program was initiated, progress has been achieved in a number of tobacco use parameters in Wisconsin, including higher rates of Wisconsin smokers making a quit attempt; increased insurance coverage for cessation counseling and medications; higher rates of discussion of cessation treatment options by clinicians; and integration of the Wisconsin Tobacco Quit Line (WTQL) into routine primary care, with almost 100,000 Wisconsin smokers using the WTQL. Nearly half of all WTQL callers were uninsured or Medicaid enrollees. Additionally, smoking rates in Wisconsin have fallen by almost 20% during this period, from about 24% of all adults in 2000 to <20% today.