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Increasing the delivery of smoking cessation care to inpatients in an Australian public health service: outcomes from a whole of health service change program
John Wiggers, Director, Hunter New England Population Health, New South Wales, Australia
Abstract
Introduction:
International guidelines recommend the provision of smoking cessation care to smokers at each contact with the health care system. Despite this, there is little evidence that system wide delivery of such care occurs at a level to produce a population benefit.
Methods:
The Hunter New England Health service in NSW Australia provides acute and community health services to approximately 850,000 people, and is staffed by approximately 15,000 staff.
An organization-wide clinical practice change program was implemented to increase the routine delivery of smoking cessation care by clinicians in all 54 inpatient facilities. The intervention involved: implementation of guidelines, staff training, implementation of assessment process and medication order procedures, and telephone support. Change in care delivery levels was assessed using a pre-post study design. Outcome measurement of NRT provision was undertaken by bedside chart audits, patient report, and staff telephone interviews.
Results:
Eighty-five inpatient wards participated in the audits and 91–95 nurse managers participated in the interviews (93% response rate). The proportion of eligible patients offered NRT increased from 51% to 92% in an 8-month period.
Conclusions:
Given the large number of smokers who are admitted to public hospitals each year, increasing the delivery of smoking care to the levels reached in this study suggests a potential for a population health benefit.
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