Smoke-Free Beginnings

1. Smoke-Free Beginnings Oklahoma State Medical AssociationJoy L. Leuthard, MS, LSWA – Principal InvestigatorSarah Jane Carlson, MBA – Project Coordinator

2. Project Background Oklahoma • Ranked as third highest state in the percentage of women who smoke • Oklahoma PRAMS data reported 32.4% of pregnant women reported smoking three months prior to pregnancy (1996-1999 data)

3. Project Background • 2001 survey of physicians in Tulsa reports that 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

4. Target Provider Population • Participants include • Family Medicine Physicians • OB/GYN Physicians • Nurse Midwifes • Nurse Practitioners • Prenatal Care Nurses • Office Staff • Most private practice

5. Target Provider Population • A group of family physicians networked together for the purpose of research and to promote the use of evidence based medicine • Physicians also recruited through the membership of the Oklahoma State Medical Association • Physicians recruited through • the Oklahoma Physicians Research Network (OKPRN)

6. Intervention Model • Through December 2005 - implementing the 5 A’s in 32 physicians practices serving smoking pregnant women • A Practice Enhancement Assistant or PEA will be paired with each participating practice

7. PEAs • PEAs from the University of Oklahoma Health Sciences Center, Department of Family & Preventive Medicine • PEAs are individuals who develop a relationship with a group of practices over a period of time, in order to help them to evaluate and improve their quality of care

8. PEAs • Quality improvement accomplished through • Practice audits and feedback • Patient satisfaction surveys • Staff training • “Cross-fertilization” • Coordination of quality improvement initiatives • Provision of specific of specific materials and resources

9. Intervention Model • PEA arranges a time to meet with each participating practice • Audits done on charts by the PEA • PEA visits participating practice on a bi-weekly basis for up to one year to facilitate implementation

10. Data Collection • A Personal Data Assistant (PDA)will be offered to chosen sites for gathering information on the use of the 5 A’s • A paper flowchart will also be available for those practices where the PDA is not usable or not chosen • PDA or paper flowchart will be used to conduct chart audits

11. Project Evaluation Process Evaluation Questions • How was the intervention implemented? • What role did the PEA play within the different practices? • How many practices used the PDA in the delivery of the intervention? • What barriers were identified to the implementation of the project? • How satisfied were the practices sites with the intervention?

12. Project Evaluation • Outcome Evaluation Questions • As a result of the intervention . . . • Were there changes in providers’ knowledge, attitudes and behaviors related to the implementation of the 5 A’s? • Did providers increase their use of the 5 A’s with their pregnant patients? • Did providers increase the number of pregnant smokers they referred to the Oklahoma Tobacco Helpline? • Impact Question • Did the intervention led to increased rates of smoking cessation among smoking pregnant patients?

13. Pilot Survey Data Provider Survey Results • Provider survey given to gather baseline data on provider activities and knowledge around prenatal smoking cessation

14. Pilot Survey Data (n=7) • 4 (57%) reported being fairly or very familiar with the 5 A’s • 6 (87%) reported asking new prenatal patients about their tobacco use • 4 (57%) reported always advising prenatal smoking patients to stop • 3 (43%) reported always assess patients readiness to quit • 1 (14%) reported being very confident in their clinic’s ability to provide an effective smoking cessation intervention with their pregnant patients

15. Pilot Survey Data • Top indicators of whether or not a practice will implement a smoking cessation intervention with patients • Receptiveness of patients • Organizational commitment • Availability of materials

16. Short-Term Products • PDA software • 5 A’s Postnatal Card • 5 A’s Prenatal and Postnatal Flowsheet (paper) • Chart Stickers (linked to flowchart)

17. Lessons Learned • Slow startup process in physician practices • Physician time is very limited • Low response rate for office-wide meeting on project particulars • Know your technological limits • Frequent communication with PEAs • Large disconnect between participating practices

18. Recommendations • Be patient, flexible • When working in the physicians practice, move at a pace they are comfortable with • KISS • “Keep it simple . . .” • Physicians have very short and sporadic time for follow-up once the project has started • Relationship with physician/staff very important • When speaking with physicians/staff – get to the point, make it simple, usable • Be consistent. Set up consistent times for visits and keep a routine when checking in with staff • Feed all involved parties

19. Recommendations • When implementing new technology • Test, test, and test again (and then test some more) • Involve committed practices in technology pilot • Put as many faces in front of technology as possible • Attend PEA meetings (weekly) • Meet them where they are • Make announcements and provide additional training at meetings if necessary • Newsletter • Quarterly newsletter informing project partners of project happenings