ASH/STCA Smoking Cessation in Secondary Care

Transcription

1 ASH/STCA Smoking Cessation in Secondary Care Researched improvements to smoking referral pathways and outcomes in a Teesside Hospital Susan Jones and Sue Perkin Glasgow - April 18 th 2013

2 OUTLINE Background and Context to the pilot and evaluation Brief overview of the models used in Secondary Care Stop Smoking Outcomes /Evaluation Lessons learnt Current picture

3 BACKGROUND Smoking Kills (DH, 1998) National Standards, Local Action (DH) 2005/ /08 Smoke Free Legislation (2007) NICE PH10 (2008)

4 MODELS of SERVICE NHS stop smoking services (SSS) commissioned in 1999 Original model (community) since weaknesses of model: lacked i) sustainability, ii) capacity and iii) strategic Trust buy in to prevention services May 2009 piloted new model the South Tees Foundation Trust Smoking Hospital Service - Evaluated by CHASE at Teesside University in 2010 The service impacts on reducing smoking prevalence and supporting a smoke-free site The service assessed 2,843 patients between May 2009 and February 2012.

5 DESIGN of evaluation - Mixed methods Summary of quantitative sample and methods Sample Secondary care pre-pilot (n=142) people seen from all PCT areas April 2008 March 2009 Secondary care pilot (n=783) people seen from all PCT areas May 2009 March 2010 Non-secondary care (n=6619) people seen from 2 PCT areas only May 2009 March 2010 Method Analysed using Excel software. Groups described and compared between datasets on following criteria where available: demographics, cigarette dependency, in/out patient, directorate, PCT, four-week quit rate, CO validated quit rate, loss to follow up.

6 DESIGN of evaluation - Mixed methods Summary of qualitative sample and methods Sample Initial patient questionnaires with pilot service users (n=44; MPCT n=24, R&CPCT n=8, OOA n=13) Method Analysed for content and themes using NVivo 8 software. Follow up telephone interviews with pilot service users (n=19; MPCT n=6, R&CPCT n=4, OOA n=8) Staff interviews (n=14; pilot team n=5, ward staff n=5) with 4 members of the pilot team interviewed at two time points System implementation survey (n=4) Commented.

7 FINDINGS - Quantitative context (1) Objective 1: Assessment of uptake of stop smoking services within secondary care quantitative data Pilot service increased uptake compared to the same period in the previous year A comparison with secondary care data for North Tees services also demonstrated a significant increase

8 FINDINGS - Quantitative context (2) Objective 2: Assessment of the impact and effectiveness of the pilot service quantitative data 783 smokers set target quit dates, of whom 215 had quit at four weeks =27% overall quit rate (validated by local SSS) Hospital team s own follow-up calls identified a four week quit rate of 42% overall (including out of area SSS)

9 FINDINGS - Quantitative context (3) LTFU rates were particularly high at 48% from secondary care initiated patients It appeared that only 2% of patients initiated in secondary care access follow-up (transition issues) CO validation rate of 7%

10 FINDINGS - Qualitative context (1) Objective 3: Assessment of patient experience Without exception the pilot service was welcomed Patients views of the effectiveness of the service were overwhelmingly positive Availability, appropriateness, effectiveness and understanding attitude of staff

11 FINDINGS - Qualitative context (2) Hospital a helpful environment in which to attempt to quit Importance of ensuring NRT was provided at the bedside and on discharge General approval of making the hospital site smoke free and discouraging smoking but tended towards designating specific areas outside for smokers

12 FINDINGS - Qualitative context (4) Objective 4: Assessment of the system of implementation and host organisation support Survey results showed staff welcomed the service and relied on it Undermined by ban on smoking in the grounds not being enforced

13 FINDINGS - Qualitative context (4) Implementation required negotiation Areas where service came under pressure: o level of support from Trust and/or Stop Smoking Service o administrative support o data management o smooth transition into non-secondary settings

14 DATA POST PILOT 2011/ Quit Dates set (QDS) 156 Quit at 4 weeks (32.1%) 2012/ QDS 116 Quit at 4 weeks (36.4)

15 LESSONS LEARNT High level Trust engagement crucial to success Importance of robust internal and transition pathways Worked well where adhered to evidence base Robust evaluation critical in shaping future commissioning and engaging partners.

16 CURRENT PICTURE Review of all Stop Smoking Service provision Implemented distributed model of SSS including GP and Pharmacy local enhanced services based on payment by results Tendering soon for Community Specialist SSS (key focus on LTC, Young People and Pregnancy) Re-commissioned Trust SSS based on block payment Begin discussion with Mental Health Trust re piloting new service Health Promoting Hospitals

17 REFERENCES Department of Health (1998) Smoking kills: a white paper on tobacco. London: Stationery Office. Department of Health (2004) National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/ /08. DH: London. Department for Communities and Local Government (2010) English Indices of Deprivation: Statistics on relative levels of deprivation in England. Available at: Jones, S. E. and Hamilton, S. Evaluation of a Stop Smoking Pilot Service in Secondary Care in James Cook University Hospital. Commissioned by Middlesbrough and Redcar and Cleveland Primary Care Trusts. January 2011.

18 REFERENCES Jones, S. E. and Hamilton, S. (2011) Smoking cessation: implementing hospital-based services. British Journal of Nursing. 20 (18): NHS Information Centre (2010a) Statistics on Smoking: England, Leeds: The Health and Social Care Information Centre. 19th August. Available at: oking_england_2010.report.pdf NICE (2008) Public health guidance 10: Smoking cessation services. NICE: London. Smoke free legislation (2007) in Health Act (2006). DH: London.