Swap to Stop : Increasing engagement of pregnant Aboriginal women who smoke in making changes to their smoking

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1 Swap to Stop : Increasing engagement of pregnant Aboriginal women who smoke in making changes to their smoking Justine Daly, Belinda Tully, Sarah Dowe, Alex Bourke, Karen Gillham Megan Freund, Flora Tzelepis Artwork by Bronwyn Bancroft July 2010 (CHA)

2 Background Smoking during pregnancy is the most important preventable cause of a range of adverse pregnancy outcomes. In NSW in % of non Aboriginal women smoked during pregnancy 45% of Aboriginal women smoked during pregnancy Quit for New Life (Q4NL) NSW Ministry of Health Funding over 5 years Implemented in each local health district across NSW Models of care variable across LHDs

3 Aim To increase routine delivery of culturally appropriate best practice smoking cessation care in Aboriginal Maternity and Child Health services. Objectives Increase offer and acceptance of: Quitline referrals Nicotine Replacement Therapy (NRT) Follow up behavioral support by services

4 Setting Hunter New England Local Health District (HNELHD) 23% of NSW s Aboriginal population 5.7% of HNE population identify as Aboriginal or Torres Strait Islander 12 Aboriginal Maternal and Infants Health Services (AMIHS) 8 Aboriginal Child and Family Health Services Building Strong Foundations or New Directions Services Approximately 55 staff

5 1. Capacity Building Approach Methods HNELHD Q4NL Model of Care Increase skills and resources of existing services and staff Tailored models for each site to facilitate ownership Executive support, staff training, systems enhancements Q4NL Support Officer monthly site support Resources site funding (additional clinical hours), Smokerlyser Machines, written materials, NRT (patches, gum, quick mist and inhalators)

6 Methods 2. Culturally appropriate care Focus on care delivery led by Aboriginal Health Workers Focus on engaging clients to begin their smoking cessation journey Follow up cessation care provided by staff

7 Methods 3. Swap to Stop What is Swap to Stop? A succinct, no fuss model that focused on reducing co levels removing judgement and motivation barriers. All smokers are offered treatment for nicotine addiction regardless of readiness to quit (opt out approach) 4 Steps Asses, Explain, Offer, Arrange

8 Methods Swap to Stop Assess: smoking status of every client using CO breath monitor (Smokerlyser) Explain: Smokerlyser reading and how to reduce the CO level to a healthy level (no longer smoking)

9 Methods Offer: NRT, Swap some or all cigarettes for NRT, set achievable goals to commence quit journey and a Quitline referral Arrange: Swap to Stop plan, monitoring CO and setting the expectation smoking will be addressed at every visit

10 Methods 4. Direct provision of free Nicotine Replacement Therapy HNELHD Clinical Guideline developed for direct provision of NRT AHW able to provide a pharmacy voucher if clinician unavailable Gum, inhalator, mist, strips, patches 5. Support for family/household members to quit Pharmacy vouchers for family members (up to 10 people) 12 weeks free NRT

11 Methods 6. Monitoring and Feedback Staff complete a monthly template for recording all client throughput and care delivery Quarterly site performance reports provided to service managers and Executive Leadership Team Targets added to HNELHD s strategic reporting tool Local operational and 90 day plans

12 Measures Monthly: % of new smoking clients Offered Quitline, NRT, Follow up Accept Quitline, NRT, Follow Up Outcome measurement point 1 - Dec 2014 Outcome measurement point 2 - Dec 2016

13 110 Results % smoking clients offered Quitline, NRT, Follow Up December 2014 December Offered Quitline % Offered NRT % Offered Follow Up %

14 Results % smoking clients accepting Quitline, NRT, Follow Up December 2014 December Accepted Quitline % Accepted NRT % Accepted F/U % Quitline: p=0.21 NRT: p < Follow Up: p <

15 Conclusions Offer of smoking cessation care increased significantly with the implementation of the HNELHD Q4NL Swap to Stop model of care. Acceptance of NRT and Follow up support has also significantly increased. Quitline acceptance remains low. Q4NL Swap to Stop model now embedded as part of routine care. Sustained change in services Future smoking rates

16 Acknowledgements Q4NL Working Group Co-authors: Justine Daly, Sarah Dowe, Belinda Tully, Alex Bourke, Karen Gillham, Megan Freund, Flora Tzelepis Art work by Bronwyn Bancroft Hunter New England Population Health is a unit of the Hunter New England Local Health District. Supported by funding from NSW Health through the Hunter Medical Research Institute. Developed in partnership with the University of Newcastle.

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