Building Capacity for Smoking Cessation Treatment Within Primary Care Teams

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1 Building Capacity for Smoking Cessation Treatment Within Primary Care Teams Justine Mascarenhas, MSc and Janine Fitzpatrick, MCogSc Investigators: Dr. Peter Selby and Dr. Laurie Zawertailo STOP Program, Nicotine Dependence Service Centre for Addiction and Mental Health May 11,

2 Disclaimer This presentation contains preliminary results and should not be quoted or cited. 2

3 Objectives Understand some of the barriers that exist to providing comprehensive smoking cessation interventions in primary care Describe the approaches that have been used to build smoking cessation capacity within primary care teams Identify some of the challenges to implementing capacity-building strategies within primary care teams 3

4 Background Tobacco dependence a leading cause of preventable death in Canada 1 Approximately 37,000 Canadians die annually of a smoking-related illness 2 Significant burden on individual health and overall healthcare system Most smokers do not use proven smoking cessation medications when trying to quit smoking 1. Health Canada (hc sc.gc.ca) 2. Heart and Stroke Foundation (heartandstroke.com) 4

5 Background Primary care practitioners ideally positioned to intervene and treat smokers who want to quit Practitioner barriers to implementing best practices for smoking cessation interventions: Time/Capacity Knowledge/Ability Cost of medication for patients Blumenthal, 2007; Vogt et al, 2005; Applegate et al, 2008; Searight,

6 Background In Feb 2011, new program by Ontario Government proposed to: i) make free Nicotine Replacement Therapy (NRT) in combination with counseling, available to patients of Ontario Family Health Teams (FHTs) ii) build capacity among FHT practitioners to provide evidence-based treatments to their patients. 6

7 Methods 1. Invitation and Capacity Assessment Invitation sent out to Ontario Family Health Teams (FHTs) to gauge interest and current capacity to implement program 2. Program Development and Implementation Program developed to increase capacity within Family Health Teams and provide evidence-based treatment to help FHT patients quit smoking 7

8 Engagement Process Feb 2011: March 2011: MHPS ed invitation to all 170 Ontario FHTs 122 FHTs (72%) responded indicating interest Individual snapshots sent to FHTs about their readiness to implement program Notification that CAMH is coordinating site Ministry contact April 2011: CAMH contacted FHTs with next steps (contract process, training opportunities etc) Additional 11 FHTs contacted CAMH expressing interest (Total respondents = 137 = 81%) CAMH contact 8

9 Capacity Assessment Results % of respondents Number of staff formally trained in delivering smoking cessation interventions 5 % of FHTs that: have practitioners interested in receiving training in smoking cessation have a locked space available for NRT storage 85% 95% to 3 4 to 5 >5 # of trained staff 9

10 Capacity Assessment Results Current implementation of best practices When are smokers asked if they are ready to quit? % of FHTs that: % of respondents actively track smokers progress have an organized smoking cessation program 56% 58% collect patient quit rates 31% 0 Annual Health Exam Every Visit If patient asks for help quitting If symptoms are smokingrelated Other 10

11 Advisory Group Representatives from all stakeholder organizations to discuss goals, progress and outcomes: Ontario Government CAMH Ontario Tobacco Research Unit Ottawa Model for Smoking Cessation Professional Bodies Healthcare organizations Non-profit organizations with an interest in tobacco control 11

12 Factors Influencing Successful Engagement Contact initially made by FHT and program funder Collaborative nature of program highlighted early Stakeholder engagement Pragmatic approach 12

13 STOP with Family Health Teams Program Enhance Practitioner Capacity practitioner Comprehensive, evidence-based smoking cessation treatment program Facilitate Knowledge Exchange knowledge broker patient Increase Patient Access to Evidence-Based Treatment designed to address barriers to implementing best practices 13

14 Enhance Practitioner Capacity Accredited training opportunities 3-5 day comprehensive course 1-day Fundamentals of Tobacco Interventions course monthly 1-hr lunch and learn webinars Training of allied health and nursing staff encouraged 14

15 Increase Patient Access to Evidence-Based Treatment Free Nicotine Replacement Therapy (NRT) Individualized Titrated to effect Combination NRT Max 4 weeks/visit; 26 weeks/year and/or Pre-assembled kit Monotherapy 5-week treatment patch gum inhaler lozenge 15

16 Increase Patient Access to Evidence-Based Treatment NRT provided with free behavioural support provided by nursing and/or allied health staff One-session Group Psychoeducation Multi-session One-on-one Intensive counselling 16

17 Facilitate Knowledge Exchange Bi-weekly teleconferences for FHT implementers to discuss successes and challenges Evaluation Patient Practitioner Organization Feedback reports 17

18 Achievements Increasing Patient Access 6392 patients at 97 FHTs have enrolled in program (July 2011 March 2012) 18

19 Achievements Enhancing Practitioner Capacity 155 practitioners from 89 FHTs have attended TEACH Core Certificate Course (May/11 May/12) 13 Lunch and Learn Webinars held (Mar/11 May/12) Apr/11: May/11: Jun/11: Jul/11: Aug/11: Sep/11: Oct/11: Nicotine Replacement Therapy Brief Tobacco Screening & Assessment Four-point plan Motivational Interviewing (1) Motivational Interviewing (2) Pharmacotherapy & Complex Patients Prescription Medications Nov/11: Dec/11: Jan/12: Feb/12: Mar/12: May/12: Tobacco Interventions for Patients with Mental Health Issues Working with Pregnant Women Who Use Tobacco Working with Aboriginal Patients Who Use Tobacco Integrated Chronic Disease Prevention Performance Clinics Art & Science of NRT Prescribing and Dispensing 19

20 Achievements Facilitating Knowledge Exchange 26 practitioner teleconferences held (June 2011-May 2012) Produced feedback report on 2011 participation 20

21 Challenges Enhancing Practitioner Capacity Patient demand exceeding staff resources Consistently making smoking cessation priority FHT demand exceeding training enrollment limits 21

22 Challenges Increasing Patient Access Systematic identification/referral of patients at all FHTs Access to other smoking cessation medications 22

23 Challenges Facilitating Knowledge Exchange Some FHTs not participating in KE activities Challenging to reach patients for follow-ups 23

24 Summary Moderate adoption of best practices at baseline Majority of Ontario FHTs expressed interest in providing more comprehensive smoking cessation treatment Still challenges to overcome to engage all FHTs and FHT patients Provision of free NRT + Increasing capacity to treat + Encouraging knowledge exchange evidence-based treatment + more sustainable smoking cessation programs 24

25 Acknowledgements STOP and TEACH Project teams Funded by Ontario Ministry of Health and Long-Term Care Family Health Team practitioners and smoking cessation practice leaders 25

26 Questions? Justine Mascarenhas x 7423 Janine Fitzpatrick janine_fitzpatrick@camh.net x

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