Helping Smokers Quit Clinicians adding value from every contact by treating tobacco dependence

Transcription

1 Helping Smokers Quit Clinicians adding value from every contact by treating tobacco dependence Eg Louise Restrick London Respiratory Network Lead Integrated consultant respiratory physician On behalf of London Senate Helping Smokers Quit Delivery Team/Programme Board Presentation to.

2 Helping smokers quit London Senate Programme Vision That every London clinician knows the smoking status of each patient they care for and has the competence and the commitment to encourage and support that patient to quit through direct action and referral. Adding value to every clinical contact with a patient who smokes by asking, advising, acting Improving the health of Londoners by building stop smoking clinical leadership and capacity

3 Londoners dying from smoking 3 1 in 5 deaths due to smoking

4 Value Framework: work with patients, improve outcomes and reduce costs stewardship of resources * includes experience for population 4 Porter ME; Lee TH NEJM 2010;363: ;

5 Londoners dying from smoking 5 1 in 5 deaths due to smoking

6 Tobacco dependence in London Impact and cost 1.2 million smoke early deaths occur each year Over 2 classrooms of children take up the habit every day (67 children) Annual health expenditure to treat smoking related illness 416 million What is our activity and spend on treating tobacco dependency?

7 Does your organisation have a dataset for all patients smoking status & interventions? No dataset Source: Survey of London providers <10% 10-30% 31-50% 51-70% 71% and over Missing

8 What smoking cessation outcomes does your organisation measure? Smokers (%) who received a medicine + repeated behavioural intervention Outcome at 4 weeks Outcome at 12 weeks Outcome at 1 year Smoking status based on exhaled carbon monoxide None Source: Survey of London providers

9 Do your organisation know how many of your staff smoke? 13 6 Smoking status recorded Smoking status not recorded Source: Survey of London providers

10 Do we treat tobacco dependence in hospital? get Right care? Less than half of smokers admitted to hospital receive very brief advice to stop as an inpatient. Murray RL et al BMJ 2013;347 : f4004 Do smokers have access to quit smoking medication? Have clinicians been trained to deliver evidence-based quit smoking interventions?

11 Do we prescribe for tobacco dependence? dpeendence? Nicotine and varenicline spend <10 per year spent per year per inpatient bed (and that is assuming spend was only on inpatients)

12 Helping smokers quit London Senate Programme Vision That every London clinician knows the smoking status of each patient they care for and has the competence and the commitment to encourage and support that patient to quit through direct action and referral. Adding value to every clinical contact with a patient who smokes by asking, advising, acting Improving the health of Londoners by building stop smoking clinical leadership and capacity

13 Helping smokers quit London Senate Programme Quit Smoking Services

14 Helping smokers quit London Senate Programme Treating tobacco dependency Long-term condition that starts in childhood Using established and evidence based pathways Collective leadership Clinically led transformational change in healthcare provider culture

15 What is High Value Respiratory Care? COPD Value Pyramid

16 Enhanced Recovery for sick smokers Evidence-based treatment of tobacco dependence Integral part of medical care Led by consultant & medical staff conversations Quit smoking advisor key member in MDT Skilled behaviour change support & medication from admission to follow-up Multiple interventions on the ward Quit Smoking Advisors 50% 6 month quit rates For highly tobacco dependent patients with varenicline and intensive support* *Ruiz J et al Nicotine and Tobacco Research 2011 *Ainley A, Pang E, Coleman B, Stern M, Restrick LJ Thorax 2014;69 (Suppl 2):A /thoraxjnl

17 Helping Smokers Quit: CO4 COnversation with every patient who smokes that gives them a chance/opportunity to quit CO monitoring used by clinicians COde the intervention so we can evaluate effectiveness including death certification COmmission the system to do this right: so right behaviours incentivised systematically. Improving the health of Londoners by building stop smoking clinical leadership and capacity

18 Helping Smokers Quit: CO4 COnversation with every patient who smokes that gives them a chance/opportunity to quit CO monitoring used by clinicians COde the intervention so we can evaluate effectiveness including death certification COmmission the system to do this right: so right behaviours incentivised systematically. Improving the health of Londoners by building stop smoking clinical leadership and capacity

19 Enabling COnversations: Clinicians trained in smoking cessation - so every patient who smokes is offered an opportunity to quit With mechanism to report back on % staff trained like staff flu vaccination

20 Enabling COnversations: Clinicians trained in smoking cessation - so every patient who smokes is offered an opportunity to quit

21 Helping Smokers Quit: CO4 COnversation with every patient who smokes that gives them a chance/opportunity to quit CO monitoring used by clinicians COde the intervention so we can evaluate effectiveness including death certification COmmission the system to do this right: so right behaviours incentivised systematically. Improving the health of Londoners by building stop smoking clinical leadership and capacity

22 CO monitoring used by clinicians CO (ppm) >20 Highly dependent Shisha smoker Cannabis smoker Cheap, quick & easy to use Diagnostic Motivational tool Outcome measure CO monitor = motivational machine

23 Helping Smokers Quit: CO4 COnversation with every patient who smokes that gives them a chance/opportunity to quit CO monitoring used by clinicians COde the intervention so we can evaluate effectiveness including death certification COmmission the system to do this right: so right behaviours incentivised systematically. Improving the health of Londoners by building stop smoking clinical leadership and capacity

24 Records of smoking as cause of death? South Africa Smoker five years ago? included on death notifications since 1998 Sitas F et al Lancet 2013:382; England Smoking as cause of death without referral to coroner since 1992 Smoking included as cause of death in fewer than 1% of deaths due to lung cancer or COPD although smoking known cause of >85% of both Proctor I et al Clin Pathol 2012;65:

25 Code: smoking on death certificates Consultant input into death certificates for all in hospital deaths Pack- years smoking recording in Part 1 for deaths due to: Lung cancer, COPD, other cancers and diseases caused by smoking Importance and confidence - TRAINING

26 Helping Smokers Quit: CO4 COnversation with every patient who smokes that gives them a chance/opportunity to quit CO monitoring used by clinicians COde the intervention so we can evaluate effectiveness including death certification COmmission the system to do this right: so right behaviours incentivised systematically. Improving the health of Londoners by building stop smoking clinical leadership and capacity

27 COmmission the system to do this right Clinical leadership and CQINS