apability, pportunity and otivation

Transcription

1 apability, pportunity and otivation Coding tobacco dependence & interventions Noel Baxter GP & Commissioner Siân Williams Programme Manager On behalf of London Senate Helping Smokers Quit delivery team Diagnosis and treatment of tobacco dependence Opportunities along life course to diagnose and treat tobacco dependence Right training, right equipment and access to the right medication.

2 In primary care and in situ where the smokers are Two videos both using CO monitor. One of ex-smoker and consultation, The other of Bulgarian GP, smoker, showing high reading and reaction. Removed as makes file very big. Available on request.

3 GP, ANC, At home, At hostel apability LTC reviews (templates, tobacco (137) read codes, also codes for motivation, Fagerstrom (minutes to first tobacco use), Exhaled CO, drug codes, non drug codes indicating treatment and type pportunity 1:5 current smokers in GP, child smokers, in-utero smokers at booking /scan /bloods/ imms. Community nurse, day centres, hostels otivation Measure impact on consultations saved acute asthma, respiratory infection

4 In hospitals

5 In hospitals Q3 A Wards DH No of NRT prescriptions No of patients admitted % patients screened No of patients who smoked Prevalence B C D E F G H I J K L M N O TOTAL % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % %

6 In hospitals apability There is no spare capacity Can treating tobacco dependence create future capacity? pportunity Vital sign measures on arrival A+E, day surgery, stroke unit. Start to populate discharge letter through electronic noting. otivation Cutting and down and quitting reduces admissions show HCPs how many beds are occupied by smokers.

7 At death and in the registrars office

8 Let s face reality: acknowledging these stages but moving on Stage 1. The data are wrong. Stage 2. The data are right, but it s not a problem. Stage 3. The data are right; it is a problem; but it is not my problem. Stage 4. I accept the burden of improvement. From Escape Fire, Don Berwick 2003

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10 Which level of behaviour change are we interested in today? Patient Clinical Organisational

11 The Behaviour Change Wheel. Michie et al 2011

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13 Right Care Pathway for Tobacco Dependent Smokers

14 Setting the context What are trusts short and medium term needs to deliver value? Where might there be alignment between treating tobacco dependence and these needs?

15 What is Right Care? The primary objective for Right Care is to maximize value: The value that the patient derives from their own care and treatment The value the whole population derives from the investment in their healthcare

16 3 types of value: Personal makes a difference to that person (care people need and want, no less and no more) Allocative investing in the right things for the population which means making choices between diseases, between populations and sub-groups Technical doing things right: getting the diagnosis right, tackling overuse/misuse (harmful and wasteful), underuse (inequitable) of treatments

17 Which of these life course metrics are the best indicators of Right Care? Deprivation, prevalence (u18, adult, maternal) Low birthweight Maternal smoking rate: SATOD % people with long term condition on primary care register who are current smokers Respiratory Tract Infection consultation rate for under 18 at primary care Respiratory Tract Infection consultation rate for adults at primary care Rate of under 18 attendance at ED with respiratory tract infection Rate of adult attendance at ED with respiratory tract infection Rate of admissions of under 18 with respiratory tract infection Rate of admissions of adults with respiratory tract infection Percentage of current beds occupied by a current smoker (defined as having quit in last four weeks or still smoking) by hospital/trust (or smoking attributable admission by CCG and by trust) % records with smoking status recorded Primary care prescribing varenicline per ASTRO PU Hospital prescribing varenicline spend and/or rate Other tobacco dependence treatment intervention eg referral or could break down by Ask, Advise, Act? A measure of frequency and consistency of review of smoking status Stillbirth rate Number of asthma deaths in smokers Mortality rate in people with severe mental illness and years of life lost Smoking attributable mortality by CCG and by trust/hospital Training in VBA by staff group and leadership team

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20 Grade as: Easy consensus [C]: most supported by those attending and those not workable in anyone s opinion Most useful in highlighting unwarranted variation [V] Most useful in motivating engagement [E] Most controversial for those attending [!] Not appropriate, but there are alternatives [A]

21 What does the system need to do to Organisational level for example: Motivation Incentive schemes Strategic alignment Specifications from commissioners Teaching Research Comparative data Opportunity Leadership Right equipment eg CO monitors, IT systems Right formulary Right information for patients Capability Training Role modelling Guidance support this?

22 What does the system need to do to support this? Policy level: Guidelines/guidance, pathways Environmental and social planning Communication and marketing Legislation Service provision Regulation Fiscal measures