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Smoking Cessation

Smoking Cessation. Compass Health Wairarapa Compass Health Capital and Coast July 2013 – January 2014. Achieving targets.

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Smoking Cessation

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  1. Smoking Cessation Compass Health Wairarapa Compass Health Capital and Coast July 2013 – January 2014

  2. Achieving targets Wairarapa DHB featured 1st place in the April –June 2013 DHB performance table for both the more heart and diabetes checks and better help for smokers to quit health targets. Remained in 1st place during the remainder of 2013. A range of actions supported this result. A three month regional Wellington/Wairarapa campaign which started back in March 2013 was the beginning of a planned approach to support practices to achieve the target.

  3. How did we do it? The Compass Health campaign involved supporting its general practice members with identifying eligible patients via a weekly list, reporting their results regularly and celebrating the successes. Community newspaper ads were placed and general practices were supported with allocating the weekly nurse hours required to meet the targets.

  4. Supporting Practices Funding, Call Centre Practice champions Emails, visits, providing support Dashboard Champix Flowcharts Weekly / Monthly Statistics updates Quit groups Media articles and adverts Display resources

  5. Media releases

  6. April to June 2013 funding formula; Smoking brief advice • Number of patients to reach the 90% target • 10 minute phone calls by Nurse to these patients at $35 per hour CVD risk assessment • Number of patients to reach 75% goal • 20minutes per free CVD consult for these patients at $35 per hour by Nurse • + a CVR co-payment of $5 for the number of patients to reach the 75% goal

  7. 2013 Actions • Calculate the gap for each practice and translate into practice specific: • Volume targets based on the gap at 1 April 2013 • Weekly nurse hours needed to achieve targets by 30 • Funding required to pay for nurse hours • Offer funding to practices willing to engage • Put in place weekly lists highlighting those high need

  8. 2013 Actions continued • Resource internally: • campaign manager, lead analyst, other staff as support • Weekly review meetings • Initial toolkit mailout to practices scripts, evidence base, how to guides, etc. • Weekly mail-outs during 2013, monthly mailout 2014, with un-blinded performance comparison, tips, and celebration of high performers (morning tea shout)

  9. 2013 Actions continued • Weekly countdown customised for each practice • Engagement with MOH to support text trial for smoking • Publicity campaign – community newspaper adds, case studies/vignette • Overall cost during 2013 was some $350,000 (but PPP earnings were about $500,000) • Duration – 13 weeks 1/4/2013 – 1/7/2013

  10. Example 2013 weekly mailout: practice comparative performance

  11. 2013 Impact - smoking • 9,325 smokers were given brief advice to quit. • % smokers given advice increased from 57% to 73% in CCDHB practices • from 63% to 96% in the Wairarapa • High need population advice rates increased to 75% in CCDHB and • to 101% in the Wairarapa.

  12. 2013 Impact - CVRA • An additional 12,768 had a coded CVRA • Increase from 58% to 76% in the Capital and Coast DHB area • Increase from 75% to 80% in the Wairarapa DHB area. • high need patient CVRA rates increased from 59.8% to 73.5% in Capital and Coast • from 70.6% to 76.7% in the Wairarapa

  13. March 63% – June 96%

  14. March 53% - June 73%

  15. Does it make a difference? • International literature suggest 2% of those given advice will quit. • Cohort analysis showed that between 5.3% & 8.3% of those who smoked 12 months ago, and who were given advice to quit, have given up smoking. • About one in 20 quit – but need a longer timeframe. • Source – Compass Health data

  16. What did practices think? • Performance all but one improved. • 1 Practice (Khandallah) moved from 31% to 94% in CVRA and from 21% to 91% in smoking. • Focus group & email feedback was mainly positive • Patient responses (anecdotal) generally very positive for CVRA

  17. Feedback: worked well • Good that it coincided with patient dashboard • “Nice to have funding attached to the activity” • “Well supported by Compass – individual help invaluable” • ‘Good way to engage with clients who had never visited’ • ‘Good that it was free’

  18. Feedback: worked well • ‘The best bit was having the actual lists of names to work off and the weekly feedback for progress.’ • ‘Wake up call to do blood pressure etc better – should entered in screening’ • Better use of the workforce – used different members of the team which hadn’t traditionally been in those roles

  19. Text advice trial – worked well • Trialled by 2 practices • Texts sent: 884 • Replies: 475 • Already quit: 91 • Declined help: 251 • Want help to quit: 118 (13.3%) • Those wanting help to quit were given follow up appointments – good way of targeting those ready to change.

  20. Feedback: could do better • Difficult time of year – flu season – Oct/Nov or Jan / Feb would be better times for this • 3 months was too short a period • Not appropriate to contact some patients – eg palliative

  21. Advice going forward • Prefer a Summer / longer timeframe • Link to practice plans to engage population • Use nursing outreach and point of care testing for disengaged group • Practice performance comparisons were generally considered useful • Could include other measures – eg cervical screening, flu. • Use PPP money to underwrite performance improvement in advance again • More emphasis on outcomes/evidence.

  22. 2014 approach • Funding provided • Monthly mailouts instead of weekly • Monthly PPP and MoH Targets Update • Smokefree, CVD, and Immunisation • A3 quarterly charts provided to show progress on all targets, CVD, Diabetes, Smoking, Cervial, Immunisation, Flu Vaccine, Breast Screening

  23. Funding model example

  24. September 2013 to June 2014 campaign • 50% of the total payment upon agreement, and the final payment when achieve the 90% targets using Apr-June 2014 data.

  25. Example of monthly practice mailout

  26. Each bar represents a GP. They were individually named in each mailout.

  27. Each bar represents a GP. Individuals were named on original

  28. Smoking Brief Advice or cessation support From 63% to 97%

  29. From 57% to 81.5% 5

  30. From 89% to 92%

  31. From 87% to 93%

  32. Signage

  33. Quit groups and resources A 50gm pouch costs around $59.00 What you could buy with $59.00 from local supermarket instead of cigarettes: Eggs $3.99 Rice $2.89 Dried pasta $2.58 Margarine $2.79 Apples- 1kg $2.49 Bananas $3.49 Bread $2.99 Broccoli x2 $3.00 Pumpkin $2.49 Cabbage $2.49 Carrots- 1kg $1.29 Potatoes $4.99 Frozen chicken $11.99 Weetbix $4.79 Milk 2 litres $3.79 Frozen Peas $2.89 ------------------------------------------------------------------------- TOTAL $58.94 What would you buy?

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