Oral Presentation

O1

INTEGRATED TOBACCO ADDICTION TREATMENT PATHWAY FOR HEAD AND NECK CLIENTS

S.McCLELLAND

Background

Smoking prevalence  in Northern Ireland (N.I.) population is around 18% , rising to 35% within acute care and is responsible for at least 16,500 hospital admissions annually. Smoking is most prevalent among disadvantaged groups and is the single greatest cause of health inequality in N.I. (Making Life Better 2016).
Smoking cessation initiatives are the single most cost-effective life-saving interventions, delivering excellent value for money, particularly for patients undergoing surgery (NICE 2016).
 
Methods

Audit of smoking cessation activity from the Oral-Maxillo Facial Surgery (OMFS) team in early 2018  identified a referral rate of 0.05% of all potential smokers.  Cognizant that specialist Stop Smoking services increase long-term quit rates by approximately four fold, this was an opportunity to improve service delivery.
Results

Since inception of this Integrated Tobacco Addiction Treatment pathway, referrals have increased  from nine in 2017/18 to 87 in 2018/19. Of those who set quit dates (n = 28) the percentage quit at 4-week review is an astonishing 88% and early audit of yearly quit rates well surpass target of 35%.

Discussion

Championed by Mr Peter Gordon and  Dr Cherith Semple, the pathway has revolutionized  access to evidence-based therapy  to treat tobacco addiction, and has positively impacted on  individuals long term prognosis, and is  likely to have reduced post operative complications and saved  bed days. (Ottawa 2010).
Implications

Plans are in place  to roll out the  pathway across other departments and use elements of CURE interventions (Cure Project Manchester)within acute care.,  The integration of tobacco addiction treatment into existing pathways will help to address the gaps identified in ‘Hiding in Plain Sight’ 2016 . 
References

www.thecureproject.co.uk 2018 
Hiding in Plain Sight 2016
Making Life Better 2013-23
NICE Guidance 2013
Ottowa Model 2010

O2

WHAT HELPS AND HINDERS IMPLEMENTATION OF AN INTERVENTION PACKAGE TO REDUCE SMOKING IN PREGNANCY

S. E. Jones(1), S. Hamilton1, R. Bell(2), V. Araújo-Soares(2), S. V. Glinianaia(2), E. M. G. Milne(3), M. White(4), M. Willmore(5)
1 School of Health & Life Sciences, Teesside University, Tees Valley, TS1 3BX
  Tel: 01642 342984. Email: Susan.Jones@tees.ac.uk
2 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
3 Newcastle City Council, Newcastle upon Tyne, UK
4 MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
5 PHE North East, Floor 2, Citygate, Gallowgate, Newcastle upon Tyne, UK

Background
Smoking in pregnancy causes harm to mother and baby (1). Despite evidence from trials of what helps women to quit, implementation in the real world has been hard to achieve (1). An evidence-based intervention (babyClear©) involving staff training, universal carbon monoxide monitoring, opt-out referral to smoking cessation services, enhanced follow-up protocols and a risk perception tool was introduced across North East England.

Question
How can the intervention be introduced successfully into routine maternity and stop smoking service care?

Objective
To identify what impedes and/or facilitates implementation

Methods
Observations of training, followed by interviews with staff from maternity (n=63) and smoking cessation services (n=33) from eight National Health Service Trust areas took place from 2013-2015. Normalization Process Theory (NPT) was used to frame the interview guides and analysis (2). 

Findings
Five main themes influenced the process of implementation: 1) initial preparedness of the organisations; 2) staff training; 3) managing partnership working; 4) resources; 5) review and planning for sustainability (3). 

Conclusion
Predicated on producing individual behaviour change in women, the intervention required elasticity from organisational structures, positive attitudes from local cultures towards learning and change, and plasticity from the mechanisms within it. These were all key to normalising the intervention package. 

References
1.    Bauld L, Graham H, Sinclair L, Flemming K, Naughton F, Ford A, et al. Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study. Health Technology Assessment. 2017;21(36).
2.    May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535-54.
3.    Jones S, Hamilton S, Bell R, Araújo-Soares V, Glinianaia SV, Milne EM, et al. What helped and hindered implementation of an intervention package to reduce smoking in pregnancy: process evaluation guided by normalization process theory. BMC Health Services Research. 2019;19(1):297.

The organisers of the First SCAH Conference would like to thank the following organisations for their support:

        

 

The Platinum Sponsors:

               

Ambivalence and the role of vaping for smokers with a mental health illness.
 Chris Pitt

Exploring the use of Carbon Monoxide (CO) screening by Health Visitors to support smoking cessation in pregnancy and the post-partum period.
Fiona Johnson

Vaping Displaces Smoking: give it a chance.
Louise Ross