Smoke-Free Beginnings

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Smoke-Free Beginnings

• A grant to the Oklahoma State Medical Association
  
• from the Robert Wood Johnson Foundations
• Smoke-Free Families National Dissemination Office

Sarah Jane Carlson, MBA Project
Coordinator carlson_at_osmaonline.org 405.843.9571
or 800.522.9452
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SFB Background

• Oklahoma
• Ranked eleventh highest state percentage of women
  who smoke
• One in seven low birth weight (LBW) newborns
  attributed to smoking during pregnancy
• Oklahoma PRAMS data reported 32.4 of pregnant
  women reported smoking three months prior to
  pregnancy (1996-1999 data)
• 2001 survey of physicians in Tulsa reports they
  were less confident in assisting patients to quit
  and in providing cessation counseling
• Two-thirds of respondents reported they were not
  knowledgeable about PHS Clinical Guidelines on
  Smoking Cessation (the 5As)

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SFB Objectives

• Increase the use of the 5 As by prenatal care
  providers
• Develop a sustainable framework for ongoing
  dissemination of the 5 As among prenatal care
  providers

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SFB Mission

• Collaborate with multiple heath care
  professionals to develop practical, feasible, and
  sustainable prenatal smoking cessation methods
• Enhance the self-efficacy of prenatal health care
  providers and their patients through the use of
  system supports to end prenatal smoking
• Promote the deliver, implementation, and
  integration of the Best Practice Guidelines in
  private and public prenatal health care settings

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Pregnant Smokers The Good News

• Growing awareness of smoking harms
• High spontaneous quit rates in pregnancy
• Best practice interventions increase quit rates
• Opportune time to treat
• 35 of women who quit in pregnancy stay quit

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5 As Best Practice Intervention

• ASK
• Ask the patient about her smoking status
• ADVISE
• Provide clear, strong advice to quit with
  personalized messages about the impact of smoking
  and quitting on mother and fetus
• ASSESS
• Assess the willingness of the patient to make a
  quit attempt within the next 30 days
• ASSIST
• Provide pregnancy specific, self help cessation
  materials
• Suggest and encourage the use of problem solving
  methods and skills for cessation
• Arrange social support in the smokers
  environment
• Provide social support as part of the treatment
• ARRANGE
• Periodically assess smoking status, and if she
  continues to smoke, encourage cessation

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Intervention Description

• Practice Enhancement Assistant (PEA) from OU
  Department of Family and Preventive Medicine
  assigned to each clinic
• Arrange time to meet with each participating
  physician and/or practice
• obtain informed consent
• schedule time for on-site training
• Over time the PEA develops relationships with
  physician(s), clinical and office staff
• gaining knowledge of each practice
• helping to implement those system changes that
  are needed to assure effective and ongoing
  implementation of the 5 As

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Intervention Description

• Initial audit of pregnant patients chart from
  previous six-twelve months conducted by PEA
• 5 As flowsheet offered to each site for
  facilitation of delivery of 5 As and for purpose
  of gathering extensive data on use of 5 As
• The PEA, through the use of 5 As flowsheet,
  conducts chart audits quarterly throughout year
  long period of implementation in each practice
• Several different types of materials available to
  use with the 5 As intervention (patient
  education materials, tear sheet, fax referral
  form, chart stickers)

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5 As Flowsheet
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How we can help you

• Healthier mothers and babies
• Specific ways to make it easier to discuss
  smoking
• Resources for patients and easy referrals
• An in-office Practice Enhancement Assistant to
  assist both physicians and staff
• Team building and increased staff satisfaction
• Increased patient satisfaction

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Who is involved

• Prenatal care providers
• Family Physicians
• OB/GYN Physicians
• Nurse Midwives
• Prenatal Care Nurses
• Staff

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Early data

• 12 sites reporting
• 406 first prenatal visits
• At baseline, 120 current smokers or former
  smokers documented
• Data from time of transition

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Documentation of smoking status at baseline by
practice (n378)
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Documentation of advise to quit provided, at
baseline, by practice (n120)
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Documentation of assess willingness to quit (stay
quit) at baseline, by practice (n78)
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Documentation of smoking status at baseline and
last audit in 8 practices
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First prenatal visit Willingness to quit (stay
quit) assessed, at baseline follow-up in 8
practices
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• Creating partnerships to assist each pregnant
  woman and her family to live free of tobacco
  addiction.