Jintana Yunibhand RN Ph D Day 4 October

Jintana Yunibhand, RN, Ph. D Day 4, October 13, 2011, Session 19 Reporting: 09/14/2011

Overview Reporting: 1) How the Thai QL has evolved its internal and external reporting as it has grown dramatically over the past 3 years? 2) How reporting stakeholders (internal and external) has changed during this period of growth? 3) How data collection needs have changed during this same period? From: Thailand Quitline Center To: Thailand National Quitline Jintana Yunibhand 09/14/2011 2

ศนยบรการ เลกบหรทางโทรศพท าต Thailand National Quitline แหงช ศนยบรการ แหงช เลกบหรทางโทรศพท าต Thailand National Quitline Initiated by Thai Wellbeing Foundation under the Tri-parties Commitment : 1. Ministry of Public Health, 2. National Health Security Office, and 3. Thai Health Promotion Foundation 3/18/2018 Jintana Yunibhand 3

Thailand Smoking rate: 1991 - 2009 Current smoking rate Regular smoking rate Occasional smoking rate Numbers of Current Smokers: 1981 = 12. 26 millions; 2009 = 10. 91 millions Jintana Yunibhand 09/14/2011 4

Thailand Smoking rate: 1991 - 2009 Numbers of Male Current Smokers: 1981 = 11. 30 m. ; 2009 = 10. 36 m. Numbers of Female Current Smokers: 1981 = 9. 53 m. ; 2009 = 5. 45 m. Male adolescents age 15 and over Female adolescents age 15 and over Jintana Yunibhand 09/14/2011 5

Thailand National Quitline: • 1993: ASH Thailand Quitline (provide reactive service with 2 lines, 2 counselors) • September 2009: Funded available by the Thai Health Promotion Foundation to the Thai Wellbeing Foundation for the development of Thailand Quitline Project from • February 2011: Achieving the status as Thailand National Quitline 3/18/201 Jintana Yunibhand 09/14/2011 6

Thailand National Quitline: • As it’s become a key component of the National Tobacco Control Program, soon, will be funded by the National Health Security Fund • Main purpose: to provide a countrywide accessible telephone service for tobacco cessation, to promote healthy lives for Thais and control the country’s tobacco consumption 3/18/201 Jintana Yunibhand 09/14/2011 7

Thailand National Quitline Goal: High effectiveness then high reach (Impacts and Accessibility) Specific Objectives: 1. Provide proactive and reactive telephone and internet counseling services 2. Sharing information and knowledge development, nationally and internationally on the topic of quitline 3. Train quit counselors, and volunteers for quitline services 4. Networking among GOs and NGOs regarding smoking cessation activities (complimentary/extension of the health care delivery system) and coordinating activities for Thailand smoke-free society Jintana Yunibhand 09/14/2011 8

Looking Dec 2009 back 2008 -2011 Start Internet services 24 database Feb 2011 system Become the Paper recorded 1 Proj. Funded National Quitline Establishing the -Personnel organization -Data base -Service model Full scale operation system -Space location installation -telephone lines Sept Aug Oct -protocols. Sept Jan 2009 2010 2011 Operation period Mar 2009 Callback services and follow-up calls 2 3 Jan 2010 Quitline Number on cigarette pack Promotion + Creating Demand Jintana Yunibhand 09/14/2011 9

Framework: Counseling Stage of changes, Evidences, Experiences- No Medication 1600 Quitline--Curative Factors – Motivation/Intention after Intention explore Pro & Con of Quitting (Readiness to and set Quit-date Quit) Confidence to – Self-efficacy/confidence to action of quitting smoking Quit with help/supports – Maintenance of Quitting with supports (1600 Quitline and self/family/social support ( 3/18/201 Jintana Yunihand Jintana Yunibhand 09/14/2011 10

Quality Monitoring System : (Scale used in training and monitoring Ask & Assess Advise & Assist Agree to all services Telephone service behaviors Telephone counseling behaviors 36 items 3/18/201 จนตนา ยนพนธ 09/14/2011 11

Quitline Promotion and Creating Demand • Public education campaign + Increase tobacco tax + Smoke-free law • Mass media campaigns by Thai Health Promotion Office • Quitline number on Cigarette Pack • Networking with Thai Health Professionals Alliance for Tobacco-Free Society-Referral • Grassroots promotion Jintana Yunibhand 09/14/2011 12

Callers pay 3 baht/call using land-line from anywhere in the Kingdom of Thailand Will be a free number, in Nov 2011 Hour of operation: Monday to Friday 730 am-800 pm Calls will be tape recorded for callback services on weekend, holidays and after hours Jintana Yunibhand 09/14/2011 13

09/14/2011

Thailand Quitline: Organization Changes Sept-Dec 08 Phone lines No. -Quit* Counselors Jan-Aug 09 Sep 09 -Aug 10 Sept 10 -Sept 11 0 0 10 9 18 16 22** 27 No. 2 5 9 8 Supporting staff *Health professionals, Nurses, clinical psychologists or Medical social workers (Full-time + Part-time) **TOTAL = 32 (Training and Screening = 8 lines) Jintana Yunibhand 09/14/2011 15

Log-in password protected Active, Inactive lines 09/14/2011

Reports by agents Inbound calls summary Outbound calls summary 09/14/2011

Data base 1 st page Summary 09/14/2011

Data entry for follow up Follow up summary 09/14/2011

FAX or WWW (U-Refer) system Networks • Hospitals • Health professional clinics • PHC • Schools • Industries • Others ARRANGE ASK ADVISE REFER Quitline ASSESS Quitline Reactive and ASSIST proactive Counseling Jintana Yunibhand 09/14/2011 20

Reporting: Thailand Quitline experiences Jintana Yunibhand 09/14/2011

Why reporting? Purposes • To gain public credibility: Quitline as a part of National Tobacco Cessation System and national tobacco control efforts • To achieve the status: Thailand National Quitline • To ensure continuation of fund Jintana Yunibhand Stakeholders • TNQ +TWF Advisory boards • Public • Health professionals and policy makers at all level of health care delivery system • National Tobacco Control Board • Thai health promotion office • Mo. PH • National Health Security Off. 09/14/2011 22

Reporting time-line: Internal Stakeholders: - Quit counselors and supporting staff: Monthly External Stakeholders: - The Thai Wellbeing Executive Board: every 4 months - The TNQ Advisory Board: every 4 months - The Thai Health Promotion Foundation: every 3 months - Public: When applicable Partners: - Thai Health Professionals Alliance for Tobacco-Free Society: Monthly - Working groups in National Tobacco Control Board and Other GOs + NGOs tobacco related groups: As often as applicable Jintana Yunibhand 09/14/2011 23

Data Collection and Analysis Jintana Yunibhand 09/14/2011

Data Sources: • MDS (Paper recorded and Data base system • Researches by external researchers Types of Reporting: -Working reports -Budget reports -Annual reports -Project reports -Books/Case studies about Quitlines -Others as requested Jintana Yunibhand 09/14/2011 25

Focus and Indicators Focus: Quality and Accessibility Indicators: • Calls volume, • Callers’ demographic data • Impact: -Quit attempts (7 day point prevalence), -QR 6 month follow up (30 day point prevalence) -CQR 6 month (Continuous abstinence for 6 mo. ) -Working protocols, curricular, evidences, and etc. Jintana Yunibhand 09/14/2011 26

TNQ: Call volume 1600 Services Outbound calls Inbound calls Proactive services Callback service (Internet clients & URefer) Reactive services 1600 Quitline Callers Proxy & interest individuals Brief intervention Proactive phone support, after QD #1 : 1 -7 days # 2: 14 days # 3: 1 month # 4: 3 months # 5: 6 months # 6: 12 months Smokers Giving Information Quit Counseling Brief intervention Protocol-based No Quit Date Protocol-based Set Quit Date Agree for -Free packages -Follow-up calls Proactive calls/callback services for Relapse prevention No interest in Future services Unable to callback Protocol-based Jintana Yunibhand 09/14/2011 27

Completed + Outgoing Calls yearly, Monthly January 2009 – September 2011 Year 2009 Completed 22, 756 Outgoing All calls 8, 380 62, 272 Average/ Month (1, 896/m) (698/m) (5, 189/m) Average/ Month 37, 385 (3, 115/m) 48, 411 85, 796 2010 2011 Jan-Sept Average/ Month Jintana Yunihand 49, 408 (5, 489/m) (4, 134/m) (7, 150/m) 68, 988 118, 396 (7, 665/m) 09/14/2011 (13, 155/m) 28

Callers: Call-in clients, call-out services & total services delivery in 3 month time and average/month (Oct 10 -Sep 11) Month Completed Outgoing Services Delivery 4, 303. 33 5, 913. 67 10, 220. 00 5, 435. 00 7, 810. 33 13, 245. 33 5, 569. 00 6, 654. 00 12, 223. 00 5465. 33 8531. 67 13997. 00 Oct-Dec 10 Average/Mo Jan-Mar 11 Average/Mo Apr-Jun 11 Average/Mo Jul-Sep 11 Average/Mo 09/14/2011

Number of calls Jan 2009 – Sept 2011 2009 2010 2011 09/14/2011

Number of calls Jan 2009 – Sept 2011 Outgoing Calls 2552 12, 000 2553 10, 341 10, 168 9, 172 7, 708 8, 000 6, 850 6, 4926, 620 6, 255 09/14/2011 1, 761 721 D ec em be be r 559 em er ob ct O m be r t 330 Se e 2, 001 1, 185 1, 280 pt e 2, 239 894 303 Ju n ay Ap ri 389 M ar ch M ry ua Fe br ua ry 472 l 411 75 0 Ja n 4, 269 2, 518 2, 000 5, 212 4, 698 4, 821 N ov 3, 870 Au 3, 692 3, 798 3, 585 ly 4, 000 Ju 6, 000 gu s 6, 505 6, 585 r 10, 000

Service delivery Jan 2009 - Sept 2011 Completed + Outgoing Calls 2553 2010 17, 439 2554 2011 15, 000 15, 551 13, 410 11, 805 09/14/2011 4, 126 r be ec em D em be r 2, 753 2, 771 be r ct o O em be r t us Se pt e Ju n ay l ri 6, 508 7, 123 3, 818 4, 240 4, 859 3, 992 3, 123 Au g 6, 429 4, 910 1, 138 936 1, 964 Ap ch M ar ry ua y Fe br ar nu 9, 736 7, 530 8, 735 ly 5, 290 790 11, 440 Ju 7, 147 5, 959 866 12, 189 11, 454 10, 920 M 11, 377 N ov 20, 000 18, 000 16, 000 14, 000 12, 000 10, 000 8, 000 6, 000 4, 000 2, 000 0 Ja 2552 2009

Callers at times of the day 3/18/201 Jintana Yunihand 09/14/2011 33

Numbers and percentage of calls made by 2010 Jan smokers or proxy Quitline Number On packs Month Proxy Smokers No Oct-Dec 10 % 2, 852 28. 00 Average/Mo 950. 67 Jan-Mar 11 1, 618 1, 305 16. 59 625 Average/Mo 312. 50 7, 332 72. 00 13. 79 3, 251. 33 8, 160 86. 21 2, 720 11. 19 3, 394. 67 8, 136 83. 41 2, 712 Average/Mo 435. 00 Jul-Aug 11 % 2, 444 Average/Mo 539. 33 Apr-Jun 11 No Total 3, 155. 00 4, 958 88. 81 2, 479 09/14/2011 2, 791. 50

Quitline callers (percentage) by age group 15 yrs 15 -18 yrs 19 -24 yrs 25 -40 yrs 41 -59 yrs 60 yrs+ Oct-Dec Jan-Mar Apr-June July-Aug 1600 Service provided (Protocol) Smokers received -counseling as in prot -set quit date to Smokers (%) 09/14/2011

1600 Quitline promotion 09/14/2011

Achievements, constraints and challenges According to current action plan and future action plan 09/14/2011

Monthly/Quarterly/Yearly report • U-Refer = 646 cases • U-Quit = 73 cases • Live Chat = 11 cases www. visits 12, 000 10, 000 Visit Unique Visitor New Visitor Return Visitor 8, 000 6, 000 4, 000 2, 000 0 ต. ค. -ธ. ค. ม. ค. -ม. ค. 09/14/2011 เม. ย. -ม. ย. ก. ค. -ส. ค.

Impacts/Outcomes of ITT (Mar-Aug 2011) (From Independent research team) • Quit attempts (7 day point prevalence), • QR 6 month follow up (30 day point prevalence) • CQR 6 month (Continuous abstinence for 6 mo. ) • satisfaction • Working protocols, curricular, evidences, and etc. Jintana Yunibhand 09/14/2011 51 49 90 39

TNQ Challenges v. Call Screening ( v. Quitline Quality Monitoring ( v. Module Learning for quit counselor v. Model/Protocol for specific populations v. Model/Protocol for integrated to PHC setting 09/14/2011

www. thailandquitline. or. th 09/14/2011

Thank You Jintana Yunibhand 09/14/2011 42