The Benefits and Challenges of Implementing a Triaged Approach to Smoking Cessation

1
The Benefits and Challenges of Implementing a
Triaged Approach to Smoking Cessation

• Lessons learned from the PEI experience

2
PEI Cessation Services

• Some context
• Brief counseling for motivation Smokers
  Helpline, health professionals
• Self help booklets, website links
• Brief counseling for quitting Smokers Helpline,
  health professionals
• Intensive counseling NRT Quit Care offered at
  5 Addiction Services sites across PEI

3
Getting Started

• Identify the value added
• In PEI this included alignment with the goals of
  the health system
• Improving the health status of Islanders
• Increasing Islanders acceptance of
  responsibility for their health
• Improving the sustainability of the system
• Right provider, right time

4
Getting started.

• Promoting the big picture
• Highlighted the full range of cessation services
• Focused on the continuum
• Modeled a new way of reflecting on the system of
  services

5
Setting the Stage Communication is essential

• Decision makers such as Minister and Deputy
  Minister of Health, Directors across divisions,
  Managers
• Physicians
• Service providers (external) CCS Cancer
  Information Service Smokers' Helpline
• Service providers (local) Provincial Addiction
  Nurses

6
Communication is essential

• NGO community
• Local Alliances PEI Healthy Living Strategy
  Steering Committee, PEI Tobacco Reduction
  Alliance (PETRA)
• Public construction of a media campaign prior
  to entry into the field
• plain language

7
Real world challenges of implementation

• A research project ? implementation
• November 2005 health system restructuring
• New employees, new responsibilities
• Loss of corporate memory

8
Addressing the challenges arising from health
care restructuring

• Establishing new connections with local
  researchers
• Re-establishing communications with local and
  external providers
• Re-establishing and promoting value added in a
  new system

9
Unexpected outcomes of triage

• Increased local research capacity
• Fostered new relationships between the team
  (researchers, government, providers)
• Increased government interest in evaluating
  cessation services

10
Unexpected outcomes of triage

• Revealed service differences within the province
• Stimulated reflection on how other services might
  be organized in a more integrated fashion

11
What does the future hold?

• Opportunities to understand how triage works with
  special populations (low literacy, pregnant women
  and adolescent smokers)
• Challenge of determining how best to promote and
  incorporate triage within a re-structured health
  system