Transcript Barriers and Enablers to the use of NRT in primary care

Catherine Marshall, Katherine Archer, Grant Carpenter,
Roy Hoerara, Debbie Ryan
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Identify the barriers faced by health practitioners
prescribing or recommending nicotine replacement
therapy
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Gather ideas and suggestions about the range of
support that would help them recommend NRT
Primary Care Practice
Practitioners
Dannevirke Medical Centre,
Total 16 people
3 GPs, 2 GP registrars, 11 nurses
Total 5 people
2 Aukati Kai Paipa advisers, 2 nurses, 1 smoking
cessation nurse from HBDHB
Taiwhenua o Heretaunga, Hastings
Taradale Medical Centre
Central Medical, Napier
Hastings Medical Centre
The Doctors Hastings
Takapau Health Centre
Total 7 people
1 GP, 6 nurses
Total 7 people
4 GPs, 1 nurse, 2 health assistants
Total 6 people
2 GPs, 4 nurses
Total 7 people
4 GPs, 3 nurses
Total 2 people
2 Nurse practitioners
17 General practitioners, 29 nurses and 2 health assistants and 2 smoking
cessation advisers.
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High awareness of the NZ Smoking Cessation Guidelines,
the ABC model and effectiveness of NRT
Increased interest from primary care patients/ clients
about quitting
64% GPs and nurses not trained in smoking cessation &
don’t know NRT products
Nurses are nervous and uncertain about the appropriate
doses - May lead to under-dosing
GPs and nurses not aware of support services for smoking
cessation
Low use of Māori or Pacific focussed smoking cessation
services
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Areas where best practice is uncertain, include:
◦ treating people with multiple addictions
◦ treating people with head injuries and/or mental health
problems
◦ combination NRT therapies and double and triple patching
◦ whether reduction in the number of cigarettes is a valid goal,
and
◦ whether patients/ clients can use NRT while smoking.
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Low community awareness that cigarette smoking is a
drug, and that it is more harmful than NRT
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Practitioners know what “ABC” stands for, but don’t
understand what brief is
GPs don’t have time to talk about smoking cessation
and NRT and aren’t paid to do this
Practitioners feel awkward/ patronising
GPs refer their patient/ client to people with a special
interest or training in smoking cessation
Nurses are highly motivated to get actively involved in
smoking cessation
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Lack of onsite access to NRT supplies creates barriers
to capturing the moment, problems of cost and access
Subsidised NRT is only available from pharmacies
Smoking cessation available at restricted times
Low public understanding of NRT, other meds and
supports available
No clear feedback and follow up for referrrals
Family and whānau not seen as part of the team
Goal of being smokefree may be too hard
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High awareness of the NZ Smoking Cessation
Guidelines, the ABC model and effectiveness of NRT
High awareness of the ways to advise use of NRT with
pregnant women
Increased interest from primary care patients/ clients
about quitting
Primary care is routinely recording smoking status
Some practices have introduced excellent smoking
cessation services eg Nurse led healthy lifestyle clinics
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Training programmes for all practitioners be reviewed
to ensure that they meet minimum competency
Face to face training or education is required to assist
busy, overworked health practitioners understand their
roles
A menu of conversation starters
GPs and practice nurses should meet advisers in their
local area
Nurses should be given wider opportunities to
participate in training on smoking cessation
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Lunchtime workshops at clinics to introduce health
practitioners to NRT products and to show them how
to use tools such as the ‘heart forecast’ tool
All training courses should provide professional
development points
Smokingcessationabc.org.nz online course updated to
have more information about the practicalities of NRT
Extend the range of people who can provide access to
subsidised NRT products eg pharmacists , community
leaders and workplace cessation advisers.
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Provide a standing order template for NRT for nurses
Electronic Quit Cards (redesigned)
Electronic follow-up systems between Quitline and
other smoking cessation specialists
Reduce read codes
Promote yourheartforecast.org.nz tool
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BPAC should conduct an audit of NRT use
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GPs suggested that smoking cessation should be
included in the PHO Performance Management System
and funding should be linked to this
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Develop a wallet card that shows much is saved and
the health benefits
Have a video of heroes/real people talking about NRT
Positive and encouraging posters
Promote greater awareness of the telephone and text
support systems available to people giving up smoking
Redefine how NRT works and tastes
Identifying ways that the family/ whānau and
workplaces can support people
Provide waiting room TV
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Focus on positive messages that promote health and
respect for the need to give up, the use of NRT and
reinforce the value of the smoker
Create a campaign with a well known icon who can talk
about giving up smoking using NRT
Highlight the specialist smoking cessation services –
want them visible to both the primary care
practitioners and community
Explain that smoking is a drug – and is more harmful
than NRT
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Clinical opinion leaders to model
ways to talk about smoking cessation
as part of routine clinical care for
chronic condition management
Create Smokefree heroes or
ambassadors (this would help
practitioners)
Create mentors for smoking cessation
advisers to offer professional support
to the nursing workforce
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Teach GPs that their role is a very limited, brief - 1
minute responsibility
Swift and effective referral to either an onsite trained
smoking cessation expert for immediate advice or Fast
track referral system to Quitline or Aukati Kai Paipa
(with electronic feedback)
Reduce the time from discussion about smoking
cessation to the point of getting NRT
Arrange services that are more convenient for smokers
and their families to attend eg evenings and weekends
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Consider value of funding more GPs time to discuss
smoking cessation
Access to samples and free demonstration packs of
NRT available through MPSO needed
Extend range of subsidised NRT products eg inhaler
Widen the range of outlets for subsidised and free NRT
Develop a network of local community mentors and
supporters
Wairua
Trained referral adviser
GP – 1
minute
message
W
Mentors
Family
and
whānau
Heroes
Whānau
Hinengaro
Champions
Workplaces
Tinana
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Promotion of NRT and pharmacotherapies to
consumers
Production of an educational video about how to use
pharmacotherapies
Development of:
◦ a downloadable consumer brochure on patches
◦ Goodfellow Unit Quizzes
◦ BPAC Case Studies and Audit
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Education sessions and launch of the new products in
March 2011.
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To the GPs and nurses of the Hawke’s Bay
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James Curtis and Carolyn Murphy HBDHB
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The Ministry of Health and PHARMAC
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The people at Silver Fern Farms Waipukurau